Risk Factors for Delayed Cerebral Ischemia in Good-Grade Patients With Aneurysmal Subarachnoid Hemorrhage

Area of Science:

• Neuroscience
• Neurology
• Critical Care Medicine

Background:

• Aneurysmal subarachnoid hemorrhage (aSAH) can lead to delayed cerebral ischemia (DCI), causing permanent disability.
• Risk factors for DCI in good-grade aSAH patients remain poorly understood.
• This study focuses on identifying specific risk factors within this patient subgroup.

Purpose of the Study:

• To identify modifiable and non-modifiable risk factors for DCI in good-grade aSAH patients.
• To stratify risk within this population to guide intensive care unit (ICU) monitoring.
• To improve outcomes by understanding predictors of DCI and DCI-related poor outcomes.

Main Methods:

• Pooled analysis of patient data from 4 clinical trials and 2 prospective cohort studies.
• Inclusion of 1918 good-grade (Glasgow Coma Scale 13-15) aSAH patients.
• Statistical analysis to determine risk estimates for DCI and DCI-related poor outcome based on clinical and lifestyle factors.

Main Results:

• Overall, 21% of patients experienced DCI and 7% had DCI-related poor outcome.
• In men, obesity and thick aSAH were associated with higher DCI rates (33%) and poor outcomes (20%).
• In women, pre-existing hypertension and thick aSAH correlated with increased DCI (28%) and poor outcomes (13%).

Conclusions:

• Increasing age, thick aSAH, obesity, and preadmission hypertension are significant risk factors for DCI in good-grade aSAH patients.
• These identified risk factors can inform targeted monitoring strategies in the ICU.
• Understanding these predictors may help prevent permanent disabilities following aSAH.