Aging Leads to Poor Outcome after Subarachnoid Hemorrhage through Exacerbating Early Brain Injury

Area of Science:

• Neurology
• Gerontology
• Neurosurgery

Background:

• Early brain injury (EBI) is a key prognostic factor in subarachnoid hemorrhage (SAH).
• Aging is also a significant prognostic factor for SAH, but its direct impact on EBI severity is not fully understood.
• Older patients often present with comorbidities and frailty, potentially influencing EBI severity.

Purpose of the Study:

• To investigate and clarify differences in EBI severity between young and older SAH patients.
• To adjust for confounding factors like comorbidities and frailty using propensity score matching.

Main Methods:

• Retrospective study of 433 SAH patients presenting within 72 hours (2013-2021).
• Patients divided into young (18-65 years) and older (≥75 years) groups.
• Propensity score matching used to balance groups for medical history, comorbidities, and frailty.

Main Results:

• The older group exhibited significantly higher World Federation of Neurosurgical Societies (WFNS) grades, Hijdra scale scores, and rates of acute hydrocephalus in both matched and unmatched cohorts.
• Propensity score matching included 98 patients (49 per group).
• Older patients demonstrated exacerbated EBI, including worse neurological damage, increased SAH volume, and higher incidence of hydrocephalus.

Conclusions:

• Aging exacerbates early brain injury following subarachnoid hemorrhage.
• Older patients face increased risks of neurological damage and hydrocephalus post-SAH.
• Understanding aging's impact on EBI is crucial for developing targeted SAH therapies.