Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage

Author:

Stienen Martin Nikolaus1,Germans Menno1,Burkhardt Jan-Karl1,Neidert Marian C.1,Fung Christian1,Bervini David1,Zumofen Daniel1,Roethlisberger Michel1,Marbacher Serge1,Maduri Rodolfo1,Robert Thomas1,Seule Martin A.1,Bijlenga Philippe1,Schaller Karl1,Fandino Javier1,Smoll Nicolas R.1,Maldaner Nicolai1,Finkenstädt Sina1,Esposito Giuseppe1,Schatlo Bawarjan1,Keller Emanuela1,Bozinov Oliver1,Regli Luca1,Serra Carlo,Krayenbühl Niklaus,Schöni Daniel,Raabe Andreas,Beck Jürgen,Goldberg Johannes,Mariani Luigi,Guzman Raphael,D’Alonzo Donato,Coluccia Daniel,Daniel Roy Thomas,Starnoni Daniele,Messerer Mahmoud,Levivier Marc,Valsecchi Daniele,Arrighi Marta,Venier Alice,Reinert Michael,Kuhlen Dominique Emmanuelle,Ferrari Andrea,Weyerbrock Astrid,Hildebrandt Gerhard,Hlavica Martin,Fournier Jean-Yves,Corniola Marco,

Affiliation:

1. From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., M.G., J.-K.B., M.C.N., N.M., S.F., G.E., E.K., O.B., L.R.); Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., D.B.); Department of Neurosurgery, University Hospital Basel, Switzerland (D.Z., M.R.); Department of Neurosurgery, Kantonsspital Aarau, Switzerland (S.M., J.F.); Department of Neurosurgery, University Hospital Lausanne, Switzerland (R.M....

Abstract

Background and Purpose— To identify predictors of in-hospital mortality in patients with aneurysmal subarachnoid hemorrhage and to estimate their impact. Methods— Retrospective analysis of prospective data from a nationwide multicenter registry on all aneurysmal subarachnoid hemorrhage cases admitted to a tertiary neurosurgical department in Switzerland (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]; 2009–2015). Both clinical and radiological independent predictors of in-hospital mortality were identified, and their effect size was determined by calculating adjusted odds ratios (aORs) using multivariate logistic regression. Survival was displayed using Kaplan–Meier curves. Results— Data of n=1866 aneurysmal subarachnoid hemorrhage patients in the Swiss SOS database were available. In-hospital mortality was 20% (n=373). In n=197 patients (10.6%), active treatment was discontinued after hospital admission (no aneurysm occlusion attempted), and this cohort was excluded from analysis of the main statistical model. In the remaining n=1669 patients, the rate of in-hospital mortality was 13.9% (n=232). Strong independent predictors of in-hospital mortality were rebleeding (aOR, 7.69; 95% confidence interval, 3.00–19.71; P <0.001), cerebral infarction attributable to delayed cerebral ischemia (aOR, 3.66; 95% confidence interval, 1.94–6.89; P <0.001), intraventricular hemorrhage (aOR, 2.65; 95% confidence interval, 1.38–5.09; P =0.003), and new infarction post-treatment (aOR, 2.57; 95% confidence interval, 1.43–4.62; P =0.002). Conclusions— Several—and among them modifiable—factors seem to be associated with in-hospital mortality after aneurysmal subarachnoid hemorrhage. Our data suggest that strategies aiming to reduce the risk of rebleeding are most promising in patients where active treatment is initially pursued. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT03245866.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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