Dataset Information

Clinical outcome and prognostic factors of patients with non-traumatic angiography-negative subarachnoid hemorrhage.

ABSTRACT:

Purpose

The cause of spontaneous subarachnoid hemorrhage (SAH) is unknown in 10% of cases. The aim of this study was to demonstrate the characteristics of patients with angiography-negative subarachnoid hemorrhage (anSAH) and to analyze factors influencing the clinical outcome in patients suffering from anSAH.

Methods

A retrospective cohort of 75 patients with anSAH [26 perimesencephalic (pmSAH) and 49 non-perimesencephalic SAH (npmSAH)] admitted between January 2016 and June 2022 was included. We analyzed demographic, clinical data and 6-month functional outcomes. Enter regression analysis was performed to identify factors associated with outcomes.

Results

Unfavorable outcome was achieved in 10 of 75 patients (13.3%). Unfavorable outcome was associated with senior adults (p = 0.008), Hijdra cistern score (HCS) elevation (p = 0.015), long-time lumbar cistern continuous drainage (LCFD; p = 0.029) and hydrocephalus (p = 0.046). The only significant risk factor for unfavorable outcome after npmSAH was the HCS (OR 1.213 (95%CI 1.007-1.462), p = 0.042).

Conclusion

Our study provides valuable information on both SAH patterns and functional outcome in patients suffering from anSAH and should be taken into consideration during management of these patients.

SUBMITTER: Geng Y

PROVIDER: S-EPMC10398389 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Clinical outcome and prognostic factors of patients with non-traumatic angiography-negative subarachnoid hemorrhage.

Geng Yibo Y Jia Jianwen J Liu Xiaoli X Li Tong T Liu He H Sun Yongquan Y Wang Yang Y

Frontiers in neurology 20230720

<h4>Purpose</h4>The cause of spontaneous subarachnoid hemorrhage (SAH) is unknown in 10% of cases. The aim of this study was to demonstrate the characteristics of patients with angiography-negative subarachnoid hemorrhage (anSAH) and to analyze factors influencing the clinical outcome in patients suffering from anSAH.<h4>Methods</h4>A retrospective cohort of 75 patients with anSAH [26 perimesencephalic (pmSAH) and 49 non-perimesencephalic SAH (npmSAH)] admitted between January 2016 and June 2022 ...[more]

PMID: 37545726

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Project description:Background/objective Uncontrolled systemic inflammation after non-traumatic subarachnoid hemorrhage (SAH) is associated with worse outcomes. Changes in the peripheral eosinophil count have been linked to worse clinical outcomes after ischemic stroke, intracerebral hemorrhage, and traumatic brain injury. We aimed to investigate the association of eosinophil counts with clinical outcomes after SAH. Methods This retrospective observational study included patients with SAH admitted from January 2009 to July 2016. Variables included demographics, modified Fisher scale (mFS), Hunt–Hess Scale (HHS), global cerebral edema (GCE), and the presence of any infection. Peripheral eosinophil counts were examined as part of routine clinical care on admission and daily for 10 days after aneurysmal rupture. Outcome measures included dichotomized discharge mortality, modified Ranked Scale (mRS) score, delayed cerebral ischemia (DCI), vasospasm, and need for ventriculoperitoneal shunt (VPS). Statistical tests included the chi-square test, Student's t-test, and multivariable logistic regression (MLR) model. Results A total of 451 patients were included. The median age was 54 (IQR 45, 63) years, and 295 (65.4%) were female patients. On admission, 95 patients (21.1%) had a high HHS (>4), and 54 (12.0%) had GCE. A total of 110 (24.4%) patients had angiographic vasospasm, 88 (19.5%) developed DCI, 126 (27.9%) had an infection during hospitalization, and 56 (12.4%) required VPS. Eosinophil counts increased and peaked on days 8–10. Higher eosinophil counts on days 3–5 and day 8 were seen in patients with GCE (p < 0.05). Higher eosinophil counts on days 7–9 (p < 0.05) occurred in patients with poor discharge functional outcomes. In multivariable logistic regression models, higher day 8 eosinophil count was independently associated with worse discharge mRS (OR 6.72 [95% CI 1.27, 40.4], p = 0.03). Conclusion This study demonstrated that a delayed increase in eosinophils after SAH occurs and may contribute to functional outcomes. The mechanism of this effect and the relationship with SAH pathophysiology merit further investigation.

Project description:To the best of our knowledge, this is the largest clinical retrospective study in AN-SAH patients, and is the first time to establish accurate predictive models paired with bleeding pattern.BackgroundAngiogram-negative subarachnoid hemorrhage (AN-SAH) has a definite incidence of delayed cerebral ischemia (DCI) and poor clinical outcomes. The purpose is to screen independent factors and establish a nomogram to guide the clinical therapy and assess post-discharge prognosis.MethodsWe identified 273 consecutive patients referred to our institute from 2013 to 2018 for AN-SAH. A nomogram to predict poor outcomes was formulated based on the multivariable models of independent risk factors. The accuracy and discrimination of nomograms were determined in training and internal validation cohorts.ResultsThe overall poor outcome rates of AN-SAH were 14.3% and 8.7% at 3 months and 12 months, respectively. In addition, perimesencephalic AN-SAH (PAN-SAH) presented with a more unfavorable prognosis compared with non-perimesencephalic AN-SAH (NPAN-SAH). The clinical prognosis was associated with the World Federation of Neurosurgical Societies scale (WFNS) (odds ratio, 3.82 [95% CI, 1.15-12.67] for 3-month outcome; and odds ratio, 31.69 [95% CI, 3.65-275.43] for 12-month outcome), Subarachnoid hemorrhage Early Brain Edema Score (SEBES) (odds ratio, 10.39 [95% CI, 1.98-54.64] for 3-month outcome; odds ratio, 10.01 [95% CI, 1.87-53.73] for 12-month outcome), and symptomatic vasospasm (odds ratio, 3.16 [95% CI, 1.03-9.70] for 3-month outcome; odds ratio, 5.15 [95% CI, 1.34-19.85] for 12-month outcome). The nomogram was constructed based on the above features, which represented great predictive value in clinical outcomes.ConclusionsSymptomatic vasospasm, high WFNS, cerebral edema, and NPAN-SAH after hemorrhage were associated with poor outcome of AN-SAH. The nomogram with WFNS (3-5), SEBES (3-4), vasospasm, and NPAN-SAH represented a practical approach to provide individualized risk assessment for AN-SAH patients.

Project description:BackgroundThe presence of traumatic intraventricular hemorrhage (tIVH) following traumatic brain injury (TBI) is associated with worse neurological outcome. The mechanisms by which patients with tIVH have worse outcome are not fully understood and research is ongoing, but foundational studies that explore prognostic factors within tIVH populations are also lacking. This study aimed to further identify and characterize demographic and clinical variables within a subset of patients with TBI and tIVH that may be implicated in tIVH outcome.MethodsIn this observational study, we reviewed a large prospective TBI database to determine variables present on admission that predicted neurological outcome 6 months after injury. A review of 7,129 patients revealed 211 patients with tIVH on admission and 6-month outcome data. Hypothesized risk factors were tested in univariate analyses with significant variables (p < 0.05) included in logistic and linear regression models. Following the addition of either the Rotterdam computed tomography or Glasgow Coma Scale (GCS) score, we employed a backward selection process to determine significant variables in each multivariate model.ResultsOur study found that that hypotension (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13-0.94, p = 0.04) and the hemoglobin level (OR = 1.33, 95% CI = 1.09-1.63, p = 0.006) were significant predictors in the Rotterdam model, whereas only the hemoglobin level (OR = 1.29, 95% CI = 1.06-1.56, p = 0.01) was a significant predictor in the GCS model.ConclusionsThis study represents one of the largest investigations into prognostic factors for patients with tIVH and demonstrates that admission hemoglobin level and hypotension are associated with outcomes in this patient population. These findings add value to established prognostic scales, could inform future predictive modeling studies, and may provide potential direction in early medical management of patients with tIVH.

Project description:BackgroundDespite having an overall benign course, non-traumatic non-aneurysmal subarachnoid hemorrhage (naSAH) is still accompanied by a risk of clinical complications and poor outcomes. Risk factors and mechanisms of complications and poor outcomes after naSAH remain unknown. Our aim was to explore the effect of stress-induced hyperglycemia (SIH) on complication rates and functional outcomes in naSAH patients.MethodsWe retrospectively reviewed patients with naSAH admitted to our institution between 2013 and 2018. SIH was identified according to previous criterion. Symptomatic vasospasm, delayed cerebral infarction, and hydrocephalus were identified as main complications. Outcomes were reviewed using a modified Rankin Scale (mRS) at discharge, 3 months, and 12 months. A statistical analysis was conducted to reveal the associations of SIH with complications and outcomes.ResultsA total of 244 naSAH patients were included in the cohort with 74 (30.3%) SIH. After adjusting for age, gender, hypertension, Hunt and Hess (HH) grade, modified Fisher Scale (mFS), intraventricular hemorrhage (IVH), and subarachnoid blood distribution, SIH was significantly associated with symptomatic vasospasm (p < 0.001, 12.176 [4.904-30.231]), delayed cerebral infarction (p < 0.001, 12.434 [3.850-40.161]), hydrocephalus (p = 0.008, 5.771 [1.570-21.222]), and poor outcome at 12 months (p = 0.006, 5.506 [1.632-18.581]), whereas the correlation between SIH and poor outcome at discharge (p = 0.064, 2.409 [0.951-6.100]) or 3 months (p = 0.110, 2.029 [0.852-4.833]) was not significant. Incorporation of SIH increased the area under curve (AUC) of ROC in the combined model for predicting symptomatic vasospasm (p = 0.002), delayed cerebral infarction (p = 0.024), hydrocephalus (p = 0.037), and 12-month poor outcome (p = 0.087).ConclusionsSIH is a significant and independent risk factor for symptomatic vasospasm, delayed cerebral infarction, hydrocephalus, and long-term poor outcome in naSAH patients. Identifying SIH early after naSAH is important for decision-making and treatment planning.

Dataset Information

Clinical outcome and prognostic factors of patients with non-traumatic angiography-negative subarachnoid hemorrhage.

Purpose

Methods

Results

Conclusion

Publications

Clinical outcome and prognostic factors of patients with non-traumatic angiography-negative subarachnoid hemorrhage.

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