gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Predictive factors for poor functional outcome in patients with acute aneurysmal subarachnoid hemorrhage independent of the initial Hunt and Hess grade

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  • M. Wostrack - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • K. Harmening - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • F. Dorn - Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München
  • Y.M. Ryang - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • B. Meyer - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • M. Stoffel - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.09.01

doi: 10.3205/12dgnc235, urn:nbn:de:0183-12dgnc2358

Published: June 4, 2012

© 2012 Wostrack et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Initial Hunt&Hess grade (HH) of subarachnoid hemorrhage (SAH) is known to predict the final clinical outcome. The aim of the study was to verify which of commonly known additional factors are associated with poor outcome.

Methods: Retrospective analysis of a prospective database of 313 consecutive patients with acute SAH (m = 100, f = 213, median age 54 (min 22, max 93)) who underwent aneurysm treatment between 03/2006 and 12/2010 in our clinic was performed. 103 patients underwent aneurysm surgery, in 210 patients endovascular aneurysm occlusion was performed. Clinical functional outcome at discharge and in follow-up was assessed according to the Glasgow Outcome Score. Follow-up is available for 81% of patients with a median interval of 26 months. The following potentially predictive variables were analyzed: gender, age, rebleeding during the hospitalisation, seizure at the ictus, size of the aneurysm, the presence of intracerebral (ICH) and intraventricular hematoma (IVH), number of cerebral aneurysms, and aneurysm treatment. Multivariate linear regression model was used to verify the possible factors predictive for the outcome. In a second multivariate linear regression model the same factors were analyzed versus HH prediction.

Results: Old age, rebleeding during the hospitalisation, IVH, and large aneurysm size (p < 0,001 for each) were identified as being significantly associated with a poor outcome. Factors predicting the high Hunt& Hess grade were the presence of the ICH (p = 0,01), the presence of the IVH (p < 0,001), and large aneurysm size (p < 0,001).

Conclusions: Only old age and rebleeding during the hospitalisation were identified as being independently predictive. Within high HH subgroups the ICH was not identified as an unfavourable prognostic factor.