Article
Predictors of the severity of aneurysmal subarachnoid hemorrhage
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Published: | June 9, 2017 |
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Objective: Treatment decision regarding unruptured intracranial aneurysms (UIA) depends on the presence of certain risk factors for aneurysm rupture. Due to the dramatic impact on the further course and functional outcome, the predictability of the initial severity of aneurysmal subarachnoid hemorrhage (SAH) is also of clinical importance. We aimed at analyzing the risk factors for the severity of SAH upon the parameters available prior to aneurysm rupture.
Methods: 955 patients with acute SAH treated at our center between January 2003 and December 2015 were included in this study. Various demographic and radiographic parameters of the patients were recorded as potential predictors. Severe SAH was defined as a poor initial clinical condition (according to the World Federation of Neurosurgical Societies Grade 4 or 5) and thick basal clot with intraventricular and/or intracerebral bleeding on computed tomography scan.
Results: The median age of the cohort was 55 years. 363 patients (38%) presented with severe SAH. Univariate analysis of demographic parameters showed that only the patients’ age significantly correlated with SAH severity (p=0.0006), whereas the sex (p=0.5708) and the race did not (p=0.8711). Larger size of the aneurysmal sack strongly predicted the severe SAH (p<0.0001), where the cutoff was set at 5 mm according to the receiver operating characteristic curve. Then, the aneurysms located at the skull base (internal carotid artery and vertebro-basilar system) were less likely to cause severe SAH, than more distally located aneurysms of the anterior circulation (p=0.0027, odds ratio (OR) =0.66). Finally, multivariate analysis confirmed independent correlation between the severity of SAH with higher age (>55 years old, p<0.0001, OR=1.76), larger size (p<0.0001, OR=1.11 per-mm-increase) and the location pattern of the aneurysm (p=0.003, OR=0.65) mentioned above.
Conclusions: The severity of SAH can be predicted prior to the bleeding event. Interestingly, common candidates for conservative management – elderly patients with UIA in the anterior circulation are at higher risk for severe SAH in case of aneurysm rupture. The size of the aneurysm remains the only parameter linking both to the rupture risk and the severity of SAH after aneurysm rupture.