gms | German Medical Science

Objective: Aneurysmal re-rupture prior to treatment is a major cause of death and morbidity in aneurysmal subarachnoid hemorrhage (aSAH). Recognizing risk factors for aneurysmal re-bleeding is particularly relevant and might help to identify the aneurysms that benefit from acute treatment. This retrospective analysis aims to determine predictors for re-bleeding after aSAH before aneurysm closure in order to identify the patients that benefit from ultra-early treatment.

Method: The incidence of re-bleeding, demographic data, and clinical data from 141 patients with aneurysmal subarachnoid hemorrhage admitted to our center between 1 January 2013 and 1 October 2015 were retrospectively collected. Clinical variables were correlated with re-bleeding events before aneurysmal repair to identify risk factors related to re-bleeding. Re-bleeding was defined as new hemorrhage or increase in hemorrhage burden on repeat CT-imaging with an acute deterioration in neurological status if the patients neurological status allowed clinical evaluation.

Results: The cumulative radiologically confirmed re-bleeding rate before aneurysm closure was 14.9%. The contingency between external cerebrospinal fluid (CSF) drainage before aneurysmal repair and re-bleeding is highly significant (p<0.001). A logistic regression through the data defines the boundary between non-re-bleeding and re-bleeding before aneurysm closure at 56.4 cc CSF drainage in 6 hours after admission (p<0.001). Also, there is a significant difference of aneurysm diameter between the re-bleeding and non-rebleeding group (p=0.044). Patients suffered from re-bleeding had a significantly worse modified ranking scale (mRS) at discharge (p=0.007), however this difference disappeared 3 months after discharge, except for a modified ranking scale of 6, which was significantly more common (p= 0.002) in patients who suffered from rebleeding.

Conclusions: The present analysis shows that external CSF drainage and the amount of CSF drainage are important risk factors for aneurysmal re-bleeding in patients with aSAH. Together with other predicting factors such as aneurysmal diameter they should be used in the clinical re-bleeding risk assessment of individual patients and a maximum drainage volume of less than 50 ml in 6 hours should be aimed before surgery.