Impact of Comorbidities and Smoking on the Outcome in Aneurysmal Subarachnoid Hemorrhage

Hammer, Alexander; Steiner, Anahi; Ranaie, Gholamreza; Yakubov, Eduard; Erbguth, Frank; Hammer, Christian; Killer‐Oberpfalzer, Monika; Steiner, Hans-Herbert; Janssen, Hendrik

doi:10.1038/s41598-018-30878-9

Cited by 35 publications

(44 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study was performed in accordance with the ethical standards laid down in the 1964 declaration of Helsinki and its later amendments. Data from the above-mentioned database were used in parts for previous publications [9][10][11] .…”

Section: Methodsmentioning

confidence: 99%

“…If smoking was quit in the past patients were not considered as smokers. For this purpose all available medical records were analysed 9 .…”

Section: Methodsmentioning

confidence: 99%

“…Finally, we want to call attention to the fact, that this work is part of a series of investigations which involve comparison of treatment after aneurysmal SAH, outcome and outcome dynamics after SAH and, within this study, LOS in ICU after SAH, where we analysed the same collective in whole or in part [9][10][11] .…”

mentioning

confidence: 99%

See 2 more Smart Citations

Impact of Complications and Comorbidities on the Intensive Care Length of Stay after Aneurysmal Subarachnoid Haemorrhage

Hammer

Ranaie

Erbguth

et al. 2020

Sci Rep

Self Cite

View full text Add to dashboard Cite

In this observational study, we analysed a cohort of 164 subarachnoid haemorrhage survivors (until discharge from intensive care) with the aim to detect factors that influence the length of stay (LOS) in intensive care with multiple linear regression methods. Moreover, binary logistic regression methods were used to examine whether the time in intensive care is a predictor of outcome after 1 year. The clinical 1-year outcome was measured prospectively in a 12-month follow-up by telephone interview and categorised by the modified Rankin Scale (mRS). Patients who died during their stay in intensive care were excluded. Complications like pneumonia (β = 5.11; 95% CI = 1.75-8.46; p = 0.0031), sepsis (β = 9.54; 95% CI = 3.27-15.82; p = 0.0031), hydrocephalus (β = 4.63; 95% CI = 1.82-7.45; p = 0.0014), and delayed cerebral ischemia (DCI) (β = 3.38; 95% CI = 0.19-6.56; p = 0.038) were critical factors depending the LOS in intensive care as well as decompressive craniectomy (β = 5.02; 95% ci = 1.35-8.70; p = 0.0077). All analysed comorbidities such as hypertension, diabetes, hypothyroidism, cholesterinemia, and smoking history had no significant impact on the LOS in intensive care. LOS in intensive care (OR = 1.09; 95% CI = 1.03-1.15; p = 0.0023) as well as WFNS grade (OR = 3.72; 95% ci = 2.23-6.21; p < 0.0001) and age (OR = 1.06; 95% CI = 1.02-1.10; p = 0.0061) were significant factors that had an impact on the outcome after 1 year. Complications in intensive care but not comorbidities are associated with higher LOS in intensive care. LOS in intensive care is a modest but significant predictor of outcomes after subarachnoid haemorrhage. Subarachnoid haemorrhage (SAH) is a devastating disease that challenges all treating disciplines. Aside from direct effects of SAH on the brain parenchyma, and directly associated complications like rebleeding, delayed cerebral ischemia, and hydrocephalus, there is evidence that further medical complications play a crucial role in the outcome after SAH 1,2. It was reported that the proportion of deaths from medical complications is comparable to the proportion of deaths attributed to the direct effects of the initial haemorrhage, rebleeding, and vasospasm 1,2. However, these complications might be preventable or at least controllable. A better outcome might be achievable with improved intensive care management 1. Beside high rates of morbidity and mortality, SAH is associated with prolonged ICU length of stay (LOS) 2-4. Initial poor clinical condition and treatment modality, but especially duration of stay in ICU, are substantial economic factors in SAH. Treatment costs of SAH in the first year easily exceed costs in the first year of ischemic stroke 5,6. Some nosocomial infections in SAH are known to determine prolonged LOS 3,7. Galea et al. reported that patients who had significantly longer LOS after SAH had unfavourable outcomes at discharge 8. However, it is uncertain whether the total LOS in ICU is a direct predictor of outcome.

show abstract

Section: Methodsmentioning

confidence: 99%

“…If smoking was quit in the past patients were not considered as smokers. For this purpose all available medical records were analysed 9 .…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Complications and Comorbidities on the Intensive Care Length of Stay after Aneurysmal Subarachnoid Haemorrhage

Hammer

Ranaie

Erbguth

et al. 2020

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…We also matched pairs of smokers and nonsmokers by WFNS grade, age, and severity of vasospasm. We chose these variables because they are reported to be the strongest predictors of outcome after aSAH [14,27]. Differences between matched pairs were calculated using the paired t test (normal distribution), Wilcoxon signedrank test (not normal distribution), and McNemar test (categorical variables).…”

Section: Statisticsmentioning

confidence: 99%

“…Several authors have found similar or lower mortality in smokers than nonsmokers after aSAH [7,14,44,51], and also functional outcome has been reported to be similar or superior in smokers [7,14,26,62]. Smokers are younger when experiencing aSAH [7,44,59], a factor that could contribute to this paradoxal outcome in smokers.…”

Section: Introductionmentioning

confidence: 95%

Impact of smoking on course and outcome of aneurysmal subarachnoid hemorrhage

2020

View full text Add to dashboard Cite

Background While the smoking-related risk of experiencing an aneurysmal subarachnoid hemorrhage (aSAH) is well established, it remains unclear whether smoking has an unexpected “protective effect” in aSAH, or if smokers are more at risk for complications and poor outcomes. Methods Prospective, observational study investigating the course and outcome of aSAH in patients admitted during the years 2011 and 2012. Smoking status at admittance, demographic, medical, and radiological variables were registered along with management, complications, and outcome at 1 year in terms of mortality, modified Rankin score, and Glasgow outcome score extended. We compared current smokers with nonsmokers on group level and by paired analysis matched by aSAH severity, age, and severity of vasospasm. Results We included 237 patients, thereof 138 current smokers (58.2%). Seventy-four smoker/nonsmoker pairs were matched. Smokers presented more often in poor clinical grade, had less subarachnoid blood, and were younger than nonsmokers. Ruptured aneurysms were larger, and multiple aneurysms more common in smokers. Severe multi-vessel vasospasm was less frequent in smokers, whereas all other complications occurred at similar rates. Mortality at 30 days was lower in smokers and functional outcome was similar in smokers and nonsmokers. Poor clinical grade, age, cerebral infarction, and vertebrobasilar aneurysms were independent predictors of 1-year mortality and of poor functional outcome. Serious comorbidity was a predictor of 1-year mortality. Smoking did not predict mortality or poor functional outcome. Conclusions Notwithstanding clinically more severe aSAH, smokers developed less frequently severe vasospasm and had better outcome than expected. The risk for complications after aSAH is not increased in smokers.

show abstract