gms | German Medical Science

Objective: Mechanisms of early brain injury (EBI) are poorly understood and predictors for early case fatality have yet to be identified. Goal of the present study was to analyze predictors and factors associated with fatal outcome within the first few days after severe subarachnoid hemorrhage (SAH).

Method: A retrospective analysis was performed for aneurysmal SAH grade 4/5 according to WFNS scale treated in our department between 11/2009 and 07/2013. According to early case fatality within the first four days, patient population was dichotomized into two groups. The population with a fatal outcome within the first four days was compared to those patients that survived this period (control group).

Results: In total, 29 female and 31 male patients with median age of 52 years (23–85y, standard error of mean, SEM: 1,4) fulfilled the inclusion criteria. 22/60 high-grade SAH patients (36.6%) died within the first four days after aneurysm with a mean survival of 2 days (0–4 days, SEM: 0,3). Male sex (p= .031), history of previous cardiac arrest, subsequent resuscitation (p= .000) and initial signs of cerebral herniation (p= .04) were clinical predictors for fatal outcome. Radiologically, infratentorial blood clot volume (p= .007), early occurrence of infarction and radiological cerebral herniation (p= .01) were radiological predictors for early case fatality. In contrast, age, aneurysm location, initial ICP, total blood clot volume, MTT and Tmax in the early PCT were not related to an early fatal outcome.

Conclusions: Male gender, history of previous cardiac arrest, initial signs of cerebral herniation, the infratentorial blood clot volume, early occurrence of infarction and radiological cerebral herniation are predictors for early case fatality. A careful preoperative evaluation, identification of risk factors and specific therapy may reduce mortality.