Artikel
WFNS grade 5 aneurysmal subarachnoid hemorrhage: If the worse comes to the worst!
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Autoren
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Marvin Darkwah Oppong
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Annika Herten
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Daniela Pierscianek
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Mehdi Chihi
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Lennart Barthel
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Philipp Dammann
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Ulrich Sure
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Ramazan Jabbarli
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Despite maximal therapy, World Federation of Neurosurgical Societies (WFNS) grade 5 aneurysmal subarachnoid hemorrhage (SAH) is strongly associated with poor outcome. However, recent advances in SAH management provided better outcome of SAH patients. The aim of this study is to identify risk factors for occurrence of WFNS grade 5 SAH and identify outcome predictors in this subgroup.
Methods: 995 SAH patients treated at our institution between January 2003 and June 2016 were eligible for this study. Electronic medical records were reviewed. Outcome was analyzed at discharge and at six month using the modified Rankin scale (mRS). Univariate and multivariate analyses were performed.
Results: WFNS grade 5 SAH was observed in 156 patients (15.7%) and independently associated with the presence of intracerebral (p<0.001, adjusted odds ratio [aOR]=5.039) and intraventricular hemorrhages (p<0.001, aOR=3.498) acute subdural hematoma (p<0.001, aOR=12.835), rebleeding (p=0.002, OR=3.188), aneurysm location (basilar artery, p=0.005, aOR=2.838) and sack size (p<0.001, aOR=1.105 per-mm-in-size-increase). Moreover, WFNS Grade 5 was independently associated with in-hospital mortality (p<0.001, aOR=1.792). However the chance to recover at 6 month follow-up was comparable to that of WFNS grade 1-4 patients (p=0.080/p=0.713 improvement to favorable outcome [mRS<3] / any decrease in the mRS-score). Within the WFNS Grade 5 sub-cohort, the occurrence of intraventricular hemorrhage (p=0.047, aOR=2.271) and age over 50 years (p=0.011, aOR=2.579) were independent outcome predictors.
Conclusion: Distribution of aneurysmal bleeding beyond the subarachnoid spaces, rebleeding, aneurysm size and location are the main risk factors for occurrence of WFNS Grade 5. These patients carry significant mortality risk, whereas those that survive have similar chances to recover like other SAH patients. Early aneurysm treatment is probably the key modifiable risk factor to reduce the rebleeding risk and, therefore, improve the outcome after severe SAH.
