Risk factors influencing prognosis in surgical patients with poor-grade aneurysmal subarachnoid hemorrhage / 中国脑血管病杂志

ABSTRACT

Objective To investigate risk factors affecting prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage(aSAH) underwent surgical intervention. Methods From January 2015 to December 2017, 142 hospitalized patients with poor-grade (World Federation of Neurosurgery [WFNS] grade IV-V) a SAH were consecutively and retrospectively enrolled in the Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University. All patients were diagnosed as spontaneous subarachnoid hemorrhage by head CT with intracranial aneurysm confirmed by CT angiography (CTA) or DSA. According to different therapeutic interventions, 142 cases were divided into the surgical treatment group (65 cases) and the conservative treatment group (77 cases). Baseline demographics,clinical data,concomitant symptoms and complications were recorded and compared between groups. Baseline demographics included sex, age, smoking history, drinking history, hypertension and diabetes mellitus; clinical data included WFNS classification, Fisher classification, pupil changes, intracerebral hematoma, intraventricular hemorrhage,aneurysm location,aneurysm diameter; concomitant symptoms of aSAH included in-hospital rebleeding,symptomatic vasospasm,symptomatic hydrocephalus,epilepsy,pulmonary infection; treatment-related complications included recurrent bleeding after discharge, cerebral infarction and intracranial infection. Risk factors affecting prognosis in surgical patients were determined using univariate analysis and multivariate Logistic regression analysis. Results (1) Lower age and proportion of ventricular hematoma were found in the surgical treatment group than the conservative treatment group,and the differences were statistically significanti [54 ± 9] years old vs. [60±12] years old.i = 2. 947; 55.4 % [36/65] vs. 77. 9% [60/77] x2 e8. 175; all P 0. 05). (2) In the terms of aneurysm re-rupture, symptomatic vasospasm, symptomatic hydrocephalus,epilepsy and pulmonary infection,no significant differences were found between the surgical treatment group and the conservative treatment group (a l l P > 0. 05). No recurrent rebleeding after discharge happened in the surgical treatment group but 13.0% (10/77) in conservative treatment group. There was significant difference between the two groups (P 0. 01). (3) Higher proportion of patients with favorable prognosis and lower mortality rate were found in the surgical treatment group than the conservative treatment group, and the differences were statistically significant (favorable prognosis rate; 60. 0% [39/65] vs. 26. 0% [20/77], x2 = 16. 803, P 0. 05). (5) Age (from low to high) and pupil changes (with or without) were analyzed using multivariate Logistic regression with unfavorable prognosis of the surgical patients as dependent variables. The results showed that advanced age (Oft = 1. 067, 9 5 % CI I. 006 - 1. 147) was an independent risk factor for unfavorable prognosis in surgical patients with poor-grade a S A H (P < 0. 05). Conclusions Compared with conservative treatment, surgical patients with poor-grade a S A H have advantages in reducing recurrent bleeding after discharge but may increase the risk of cerebral infarction and intracranial infection. However,the overall prognosis of surgical patients is better. Advanced age is an independent risk factor for unfavorable prognosis of surgical patients with poor-grade aSAH.