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Open Access 01-12-2024 | Aneurysm | Original Article

Risk factors for poor outcome after aneurysmal subarachnoid hemorrhage in patients with initial favorable neurological status

Authors: Annika Lenkeit, Marvin Darkwah Oppong, Thiemo Florin Dinger, Meltem Gümüs, Laurèl Rauschenbach, Mehdi Chihi, Yahya Ahmadipour, Anne-Kathrin Uerschels, Philipp Dammann, Cornelius Deuschl, Karsten H. Wrede, Ulrich Sure, Ramazan Jabbarli

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Background

Aneurysmal subarachnoid hemorrhage (aSAH) remains a devastating diagnosis. A poor outcome is known to be highly dependent on the initial neurological status. Our goal was to identify other parameters that favor the risk of complications and poor outcome in patients with aSAH and initially favorable neurologic status.

Methods

Consecutive aSAH cases treated at our hospital between 01/2003 and 06/2016 with the initial World Federation of Neurosurgical Societies grades I–III were included. Data on demographic characteristics, previous medical history, initial aSAH severity, and functional outcome after aSAH were collected. The study endpoints were the occurrence of cerebral infarcts, in-hospital mortality, and unfavorable outcome at 6 months after aSAH (modified Rankin scale > 3).

Results

In the final cohort (n= 582), the rate of cerebral infarction, in-hospital mortality, and unfavorable outcome was 35.1%, 8.1%, and 17.6% respectively. The risk of cerebral infarction was independently related to the presence of acute hydrocephalus (adjusted odds ratio [aOR]=2.33, p<0.0001), aneurysm clipping (aOR=1.78, p=0.003), and use of calcium channel blockers concomitant to nimodipine (aOR=2.63, p=0.002). Patients’ age (>55 years, aOR=4.24, p<0.0001), acute hydrocephalus (aOR=2.43, p=0.036), and clipping (aOR=2.86, p=0.001) predicted in-hospital mortality. Baseline characteristics associated with unfavorable outcome at 6 months were age (aOR=2.77, p=<0.0001), Fisher grades III–IV (aOR=2.81, p=0.016), acute hydrocephalus (aOR=2.22, p=0.012), clipping (aOR=3.98, p<0.0001), admission C-reactive protein>1mg/dL (aOR=1.76, p=0.035), and treatment intervals (aOR=0.64 per-5-year-intervals, p=0.006).

Conclusions

Although cerebral infarction is a common complication in aSAH individuals with favorable initial clinical condition, >80% of these patients show favorable long-term outcome. The knowledge of outcome-relevant baseline characteristics might help to reduce the burden of further complications and poor outcome in aSAH patients who tolerated the initial bleeding event well.

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Title: Risk factors for poor outcome after aneurysmal subarachnoid hemorrhage in patients with initial favorable neurological status
Authors: Annika Lenkeit
Marvin Darkwah Oppong
Thiemo Florin Dinger
Meltem Gümüs
Laurèl Rauschenbach
Mehdi Chihi
Yahya Ahmadipour
Anne-Kathrin Uerschels
Philipp Dammann
Cornelius Deuschl
Karsten H. Wrede
Ulrich Sure
Ramazan Jabbarli
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Aneurysm
Aneurysm
Hydrocephalus
Hydrocephalus
Hydrocephalus
Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
Intracranial Hypertension
Diagnostics in Neurology
Nimodipine
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-05968-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for poor outcome after aneurysmal subarachnoid hemorrhage in patients with initial favorable neurological status

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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