Predictors of Poor Quality of Life 1 Year After Subarachnoid Hemorrhage

Taufique, Zahrah; May, Teresa; Meyers, Emma; Falo, Cristina; Mayer, Stephan A.; Agarwal, Sachin; Park, Soo‐Jin; Connolly, E. Sander; Claassen, Jan; Schmidt, J. Michael

doi:10.1227/neu.0000000000001042

Cited by 123 publications

(96 citation statements)

References 41 publications

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“…The mean time in our ICU was 19 days (4-76 days; SD +/− 9.8) with a median stay of 17 days. This is a relatively high LOS compared to other studies 3,7,8,19,26 . For example, Dasenbrock et al used the data from 7,516 admissions after subarachnoid haemorrhage from the Nationwide Inpatient Sample and reported a median total hospital stay for the population of 16 days (11-23 days) 19 .…”

Section: Discussioncontrasting

confidence: 50%

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

Hammer

Ranaie

Erbguth

et al. 2020

Sci Rep

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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.

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Section: Discussioncontrasting

confidence: 50%

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

Hammer

Ranaie

Erbguth

et al. 2020

Sci Rep

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“…Fifty-one of 55 studies (93%) used one of the following screening or rating scales to ascertain the presence of depression: Hospital Anxiety Depression Scale (HADS), 18,19,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Beck Depression Inventory (BDI), [12][13][14][15][16][17][18][19][20][21][40][41][42][43][44][45][46][47][48][49][50][51] Center for Epidemiologic Studies Depression (CESD), [22][23][24]52,53 Montgomery Åsberg Depression Rating Scale (MADRS), 54,55 Geriatric Depression Scale (GDS), 56,57 International Classification of Diseases...…”

Section: Resultsmentioning

confidence: 99%

Depression after Subarachnoid Hemorrhage: A Systematic Review

et al. 2020

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Background and Purpose Depression is common and debilitating illness accompanying many neurological disorders including non-traumatic subarachnoid hemorrhage (SAH). The aim of this systematic review was to identify and critically appraise all published studies that have reported the frequency, severity and time course of depression after SAH, the factors associated with its development and the impact of depression on patients’ quality of life after SAH.Methods The PubMed database was searched for studies published in English that recruited at least 40 patients (>18 years old) after SAH who were also diagnosed with depression.Results Altogether 55 studies covering 6,327 patients met study entry criteria. The frequency of depression ranged from 0% to 61.7%, with a weighted proportion of 28.1%. Depression remained common even several years after the index SAH. Depression after SAH was associated with female sex, premorbid depression, anxiety, substance use disorders or any psychiatric disorders, and coping styles. Comorbid cognitive impairment, fatigue, and physical disability also increased the risk of depression. Aneurysmal SAH and infarction may be related to depression as well. Depression reduces the quality of life and life satisfaction in patients after SAH.Conclusions Depression is common after SAH and seems to persist. Further research is needed to clarify its time course and identify the neuroendocrine and neurochemical factors and brain circuits associated with the development of post-SAH depression. Randomized controlled treatment trials targeting SAH-related depression are warranted.

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“…RTW is an important factor to consider after a SAH. Previous research has shown that persons with SAH were least satisfied with their vocational situation at follow-up (12) and no-RTW is associated with a poor quality of life (11,21).…”

Section: Discussionmentioning

confidence: 98%