Systemic Severity and Organ Dysfunction in Subarachnoid Hemorrhage: A Large Retrospective Multicenter Cohort Study

Area of Science:

• Neurology
• Critical Care Medicine
• Biostatistics

Background:

• Subarachnoid hemorrhage (SAH) frequently leads to acute physiological derangements and multiple organ dysfunction.
• Predicting in-hospital mortality in SAH patients is crucial for timely intervention and resource allocation.

Purpose of the Study:

• To evaluate the predictive performance of the Simplified Acute Physiology Score 3 (SAPS-3) and Sequential Organ Failure Assessment (SOFA) scores for in-hospital mortality in a large SAH patient cohort.
• To assess the utility of non-neurological components of these scores (nSAPS-3 and nSOFA) in mortality prediction.

Main Methods:

• Retrospective analysis of prospectively collected data from 45 ICUs in Brazil (2014-2015).
• Inclusion of patients with non-traumatic SAH.
• Recording of non-neurological SAPS-3 (nSAPS-3), non-neurological SOFA (nSOFA), and World Federation of Neurological Surgeons (WFNS) scale scores.
• Multilevel logistic regression and AUROC analysis to evaluate predictive performance.

Main Results:

• The study included 997 SAH patients; 34% experienced in-hospital mortality.
• Non-survivors were older, with higher nSAPS-3 and nSOFA scores, and more often had poor neurological grade.
• Multivariable analysis identified nSAPS-3 and nSOFA as independent predictors of mortality.
• The combined model of nSAPS-3 and nSOFA significantly improved prediction accuracy (AUROC 0.89) compared to age and WFNS alone (AUROC 0.85).

Conclusions:

• Non-neurological SAPS-3 (nSAPS-3) and SOFA (nSOFA) scores are independently associated with in-hospital mortality following SAH.
• Incorporating nSAPS-3 and nSOFA scores enhances the early prediction of mortality in SAH patients.
• These scores should be considered for integration into prognostic indices for early SAH assessment.