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Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage
J Mocco1, Evan R Ransom, Ricardo J Komotar
1Department of Neurological Surgery, Columbia University, New York, New York 10032, USA.
Insights
Predicting outcomes for poor-grade aneurysmal subarachnoid hemorrhage (SAH) is crucial. Key predictors of poor 12-month outcomes include older age, hyperglycemia, severe Hunt and Hess Grade V, and larger aneurysm size.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (SAH) is a critical neurological emergency.
- Poor-grade SAH (Hunt and Hess Grades IV-V) is associated with high morbidity and mortality.
- Predictive tools are needed to assess prognosis in these patients.
Purpose of the Study:
- To identify predictors of 12-month outcomes in poor-grade aneurysmal SAH.
- To develop a preoperative index for prognosis assessment.
- To evaluate the impact of various clinical factors on SAH outcomes.
Main Methods:
- Analysis of prospectively collected data from poor-grade aneurysmal SAH patients.
- Application of survival analysis and Kaplan-Meier curves.
- Multivariable logistic regression to identify significant outcome predictors.
Main Results:
- No significant difference in survival between open surgery and endovascular treatment.
- Forty percent of patients achieved a favorable 12-month outcome.
- Predictors of poor outcome: age >65, hyperglycemia, Hunt and Hess Grade V, aneurysm size ≥13 mm.
- Development of a Prognosis Score based on these predictors.
Conclusions:
- Patient age, preoperative Hunt and Hess grade, and aneurysm size are strong outcome predictors.
- Hyperglycemia is a potentially modifiable risk factor for poor outcomes.
- The Prognosis Score aids in preoperative assessment of outcomes for poor-grade aneurysmal SAH.
Objective:
To evaluate which presentation indices, demographics, and clinical information predict 12-month outcome in poor-grade aneurysmal subarachnoid hemorrhage (SAH), and to provide a preoperative index of prognosis.
Methods:
Data were obtained on all patients with poor-grade (Hunt and Hess Grades IV and V) aneurysmal SAH from a prospectively maintained SAH database and health outcomes project. Demographics, medical history, presenting clinical condition, and health outcomes were analyzed. Survival analysis was performed and Kaplan-Meier curves were generated. Multivariable logistic regression analysis was used to identify significant predictors of poor outcome at 12 months after hemorrhage, as measured by the modified Rankin disability scale.
Results:
Survival curves for open surgery and endovascular treatment did not differ significantly. Overall, 40% of the 98 definitively treated patients had a favorable outcome at 12 months. Multivariable analysis identified patient age older than 65 years (P < 0.001), hyperglycemia (P < 0.03), worst preoperative Hunt and Hess Grade V (P < 0.0001), and aneurysm size of at least 13 mm (P < 0.002) as significant predictors of poor outcome. These variables were weighted and used to compute a poor-grade aneurysmal SAH Prognosis Score (hereafter, Prognosis Score) for each patient. A Prognosis Score of 0 was associated with a 90% favorable outcome; Prognosis Score of 1 with 83%; Prognosis Score of 2 with 43%; Prognosis Score of 3 with 8%; Prognosis Score of 4 with 7%; and a Prognosis Score of 5 with 0%.
Conclusion:
Outcome in poor-grade aneurysmal SAH is strongly predicted by patient age, worst preoperative Hunt and Hess clinical grade, and aneurysm size. Hyperglycemia on admission after poor-grade aneurysmal SAH increases the likelihood of poor outcome, and is a potentially modifiable risk factor. The Prognosis Score is a useful tool for preoperatively assessing the likelihood of a favorable outcome for poor-grade aneurysmal SAH patients.
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