Prediction of Outcomes in Young Adults With Aneurysmal Subarachnoid Hemorrhage

Abstract

Subarachnoid hemorrhage (SAH) is rare in young adults and little is known about aneurysms in this subgroup. The effect of clinical and prognostic factors on the outcome based on the Glasgow Outcome Scale (GOS) scores and the predictors of unfavorable outcomes were analyzed in young adults with aneurysmal SAH. A retrospective review of the clinical parameters, including age, sex, hypertension, smoking status, hyperlipidemia, location of the cerebral aneurysm, size of the aneurysm, multiplicity, perioperative complication such as hydrocephalus, vasospasm, and hematoma, and Hunt and Hess and Fisher grading on presentation, was conducted in 108 young adults (mean age 34.8 years) managed at our institute. The outcome was classified based on GOS grading into unfavorable (GOS scores 1-3) or favorable (GOS scores 4 or 5). The overall mortality rate was 3.7% (4/108 patients). Univariate regression analysis for the outcomes at discharge found that age at the time of presentation, male sex, size of aneurysm, multiple aneurysms, hyperlipidemia, and poor Hunt and Hess and Fischer grades were associated with unfavorable outcome. Multivariate regression analysis found independent effects of sex, multiple aneurysms, size of aneurysm, and Hunt and Hess grade on the outcome at discharge. Size of aneurysm, presence of multiple aneurysms, Hunt and Hess grade, and hypertension were the predictors of outcome at mean 2-year follow up based on multivariate exact regression analysis. The multimodal approach with aggressive medical management, early intervention, and surgical treatment might contribute to favorable long-term outcomes in patients with poor expected outcomes.

Low neurologic intensive care unit hemoglobin as a predictor for intra-arterial vasospasm therapy and poor discharge modified Rankin Scale in aneurysmal subarachnoid haemorrhage-induced cerebral vasospasm

“…The Hunt and Hess grade has been shown to be an independent predictor of poor outcomes in aneurysmal subarachnoid hemorrhage, and this was also noted in our study 15. To our knowledge, this is the first report to show Hunt and Hess grade as an independent predictor of IAVT.…”

Prognostic factors in patients underwent aneurysmal clipping surgery due to spontaneous subarachnoid hemorrhage

“…Chotai et al found in a univariate regression analysis of the outcomes at discharge that the age of the patient at the time of presentation and male gender were predictors of an unfavorable outcome. A multivariate regression analysis showed the independent effects of gender on the outcome at discharge in 108 young adult patients (6). Although there are also reports suggesting that age and sex have no prognostic value (3,11,14,20).…”

“…Chotai et al (6) also found that the size of the aneurysm and the presence of multiple aneurysms were associated with unfavorable outcomes. In young adult patients, the size of an aneurysm and the presence of multiple aneurysms were found to be predictors of outcome at mean two years of follow up (6). Similar to other studies, …”

“…Based on a multivariate exact regression analysis, hypertension was found to be a predictor of outcome at a mean two-year follow up (6). elevated blood pressure and the presence of a preexisting medical illness are predictive of mortality (16).…”

“…Taking the day of the hemorrhage as day 0, surgical intervals were defined either as immediate (day 0), early (days 1-3), intermediate (days [4][5][6][7][8][9][10][11][12][13][14] or late (days after 14).…”