gms | German Medical Science

Objective: Several factors such as age and delayed cerebral ischemia (DCI) have been already identified as outcome determinants after aneurysmal subarachnoid hemorrhage (aSAH). In the last years, a growing evidence has evolved pointing out that aSAH should be rather regarded as a systemic disease affecting multiple organ systems than as injury restricted to the brain. Hence, the presence of comorbidities and the extracerebral organ functions at the time of aSAH diagnosis are gaining an increasing importance for early outcome prediction in aSAH patients. The aim of this study was to evaluate the impact of disease burden on in-hospital mortality and functional outcome after aSAH.

Methods: A retrospective analysis of a consecutive patient cohort with aSAH treated from 2012 to 2020 was performed. The disease burden at the time of diagnosis was evaluated applying the Charlson Comorbidity Index (CCI), the ASA Physical Status System (ASA) on the one side and the assessment of organ function according to the Simplified Acute Physiology Score (SAPS II) 24 hours after admission on the other side. Functional outcome was assessed using the modified Rankin scale (mRS) at 3 months follow up.

Results: A total of 315 patients with mean age of 55.6 years and a good WFNS-grade (I-III) in 58.7% (185/315) were included. The mean mRS after 3 months was 1.6±1.9. Significant comorbidities (CCI > 3) were found in 26% (82/315) of the patients. Significant physical performance impairment (ASA 3-5) had 46.7% (147/315) of all patients. All three scores correlated significantly with functional outcome (p<0.0001). The best performance predicting functional outcome showed SAPS II (AUC 0.74), followed by ASA (AUC 0.65), and the CCI (AUC 0.64). A SAPS II cut-off value of 28 could significantly discriminate patients with good from those with poor outcome (mRS > 3), with a mortality rate of 2.8% in the group with SAPS II < 28 compared to 11.8% in the group with SAPS II >=28 (p<0.0001). The DCI-incidence did not differ significantly between the two groups (16.7% vs 22.1%, p=0.22).

Conclusion: The disease burden encompassing the comorbidities on the one side and the organs function at aSAH presentation on the other side significantly impacted the outcome of the patients at 3 months follow-up, independently of the DCI incidence. These results support the hypothesis that aSAH should be regarded as a systemic disease and highlight the necessity of integration of multiple organ function in the early outcome prediction after aSAH.