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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Predictors of in-hospital death following aneurysmal subarachnoid hemorrhage – analysis of a nationwide database (Swiss SOS)

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  • Martin N. Stienen - Klinik für Neurochirurgie, UniversitätsSpital Zürich, Zürich, Switzerland
  • Jan-Karl Burkhardt - Zürich, Switzerland
  • Marian Christoph Neidert - University Hospital Zurich, Department of Neurosurgery, Zürich, Switzerland
  • Christian Fung - Inselspital Universität Bern, Klinik für Neurochirurgie, Bern, Switzerland
  • Bawarjan Schatlo - Universitätsklinik Göttingen, Klinik f. Neurochirurgie, Göttingen, Deutschland
  • Philippe Bijlenga - Neurochirurgie, Dpt de Neurosciences cliniques, Genf, Switzerland
  • Karl Schaller - Hôpitaux Universitaires de Genève, Neurochirurgie, Genève, Switzerland
  • Emanuela Keller - Kilchberg, Switzerland
  • Oliver Bozinov - Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Switzerland
  • Luca Regli - UniversitätsSpital Zürich , Klinik für Neurochirurgie, Zürich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.05.05

doi: 10.3205/17dgnc208, urn:nbn:de:0183-17dgnc2086

Published: June 9, 2017

© 2017 Stienen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: To identify predictors of in-hospital mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: Retrospective analysis of prospective nationwide data from a multicenter registry on all aSAH cases admitted to a tertiary neurosurgical department in Switzerland between 2009 – 2014 (Swiss SOS). Patients admitted alive but dead at discharge (in-hospital mortality) were identified and both clinical and radiological predictors of death (adjusted odds ratios (aOR)) were identified using multivariate logistic regression analysis.

Results: Of n=1866 patients admitted alive with aSAH, in-hospital mortality was 20.0% (n=373) with death occurring within 48h of ictus in 35.7% (n=133). Independent predictors of in-hospital mortality at admission were uni- or bilateral pupil dilatation (aOR 3.68, 95%CI 2.33-5.83, p<0.001), followed by high WFNS grade (4 and 5; aOR 3.02, 95%CI 1.99-4.58, p<0.001), presence of intraventricular hemorrhage (aOR 2.66, 95%CI 1.73-4.09, p<0.001), age ≥ 60 years (aOR 95%CI 1.99, 1.36-2.89, p<0.001), and midline shift (aOR 1.61, 95%CI 1.03-2.53, p=0.039). Male patients were as likely as female patients to die (aOR 1.34, 95%CI 0.90-1.98, p=0.149). Patients not receiving curative therapy were more likely to die (aOR 14.11, 95%CI 9.16-21.73, p<0.001), as were patients with aneurysm re-bleeding (aOR 8.21, 95%CI 4.25-15.86, p<0.001), and those experiencing delayed cerebral ischemia (aOR 2.93, 95%CI 1.91-4.50, p<0.001). The rates of in-hospital mortality were 11.02% after a clipping and 12.55% after a coiling procedure. Finally, infarction on post-treatment CT scan was a predictor of death (OR 2.09, 95%CI 1.51-2.89, p<0.001).

Conclusion: The unselected nationwide database allows for accurate determination of the effect size of important predictors of in-hospital mortality. The highest independent risk factors were re-bleeding (aOR 8.21), pupil dilatation at admission (aOR 3.68) and high WFNS grade (aOR 3.02).