Article
Outcome and prognostic factors in poor grade patients (WFNS IV-V) with aneurysmal subarachnoid hemorrhage
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Authors
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Nina Brawanski
- Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
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Sepide Kashefiolasl
- Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
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Daniel Dubinski
- Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
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Christian Senft
- Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
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Volker Seifert
- Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
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Jürgen Konczalla
- Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Patients with aneurysmal subarachnoid hemorrhage (SAH) are graded in five groups according to WFNS depending on admission status. We questioned, whether there are differences in outcome and prognostic factors and divided patients with aneurysmal SAH into two groups (good admission status (WFNS I-III) vs. worse admission status (WFNS IV-V)). In addition, we evaluated whether there are differences in the duration of stay on intensive care unit (ICU) between these groups and if- in case of worse admission status- the stay in the ICU influences patients’ outcome.
Methods: Patients with SAH were entered into a prospectively collected database. We looked for differences in outcome and prognostic factors between these two groups. Data collected were sex, early hydrocephalus and shunt dependence, occurrence of Fisher-3 bleeding and intracerebral hemorrhage (ICH), severe CVS and aneurysm treatment. Outcome was assessed using the modified Rankin Scale (mRS; favorable (mRS 0-2) vs. unfavorable (mRS 3-6)) six months after SAH.
Results: A total of 1003 patients were selected, of whom 554 (55.2%) patients showed good and 449 (44.8%) patients worse admission status (WFNS I-III vs. WFNS IV-V. Patients with WFNS IV-V had significantly more often an early hydrocephalus (p< 0.001), shunt dependence (p< 0.0001), Fisher-3 bleeding pattern (p< 0.0001) and ICH (p< 0.0001) compared to WFNS I-III patients. Furthermore, these patients suffer more often from severe CVS (p= 0.04). Rate of patients with WFNS IV-V receiving aneurysm treatment (clip or coil) is significant lower (p= 0.0003). Patients with treated aneurysms had a significant better outcome (p= 0.01). As expected in subgroup analysis (WFNS I-III vs. WFNS IV-V), outcome in patients with WFNS IV-V is worse (p< 0.0001) and mortality rate is significant higher (p> 0.0001). But still 39% of patients with WFNS IV-V showed favorable outcome. Strong prognostic factor beside aneurysm treatment in patients with WFNS IV-V is an ICH (p< 0.0001). At least length of stay (LOS) on ICU in patients with WFNS IV-V has no influence on outcome (favorable outcome 15.91 days vs. unfavorable outcome 15.57 days).
Conclusion: Patients with WFNS IV-V have a worse outcome and a higher mortality rate. Factors influencing outcome in patients with WFNS IV-V are aneurysm treatment and ICH, whereas LOS did not influence patients’ outcome. Despite the initial poor prognosis, 39% of patients achieved a favorable outcome.
