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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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The role of previous medical history on the initial severity and functional outcome of subarachnoid haemorrhage in elderly patients

Die Rolle der medizinischen Vorgeschichte für den anfänglichen Schweregrad und das funktionelle Ergebnis einer Subarachnoidalblutung bei älteren Patienten

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  • presenting/speaker Annika Herten - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Leonie Droste - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Thiemo Florin Dinger - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Mehdi Chihi - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Karsten Henning Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP210

doi: 10.3205/21dgnc491, urn:nbn:de:0183-21dgnc4914

Published: June 4, 2021

© 2021 Herten 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

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Objective: Aneurysmal subarachnoid hemorrhage (SAH) presents a devastating diagnosis for elderly individuals. The clinical value of comorbidities for elderly SAH patients remains unclear. The aim of the study was to analyze the impact of previous medical history and medication on the course of SAH in elderly patients.

Methods: All consecutive SAH cases aged ≥65 years old who were treated in our hospital between 01/2003 and 06/2016 were eligible for this study. The data on comorbidities, previous medication, as well as initial severity, secondary complications of and the outcome after SAH were collected from the electronic medical records. The primary endpoints of the study were: [a] occurrence of cerebral infarcts; [b] in-hospital mortality, and [c] unfavorable outcome at 6 months after SAH defined as modified Rankin scale > 3. The associations were confirmed in the uni-and multivariate analysis.

Results: The final analysis included 246 elderly patients (mean age: 73.6 years, 71.1% females). The rates of cerebral infarcts, in-hospital mortality and unfavorable outcome were 55.6%, 29.7% and 60.2% respectively. Only cardiac morbidity was associated with initial clinical SAH severity, WFNS 4-5 (aOR=1.723, p= 0.046). Of all analyzed secondary complications, only aneurysm re-bleeding (aOR=7.63, p=0.008 / aOR=4.43, p=0.002 / aOR=3.05, p=0.109 for [a], [b] and [c] respectively) and pneumonia (aOR=2.21, p=0.027 / aOR=1.07, p=0.839 / aOR=1.73, p=0.302) were independently associated with one or more of the primary endpoints. In turn, patients with cardiac morbidity were prone to aneurysm re-bleeding (aOR=5.96, p=0.001) and individuals taking the medication with ACE inhibitors were at higher risk of pneumonia (aOR=1.93, p=0.049). The patients with the calcium channel blockers were at higher risk for cerebral infarcts (aOR=2.75, p=0.025). Finally, cardiac morbidity was independently associated with all primary endpoints (aOR=1.95, p=0.048 / aOR=2.25, p=0.014 / aOR=2.71, p=0.027).

Conclusion: Elderly SAH patients are at high risk for poor functional outcome. Particularly, the presence of cardiac comorbidity might complicate the course and outcome of SAH in elderly individuals.