open access

Vol 48, No 5 (2014)
Review article
Submitted: 2014-06-16
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Risk factors for re-bleeding of aneurysmal subarachnoid hemorrhage: Meta-analysis of observational studies

Gobran Taha Ahmed Alfotih, FangCheng Li, XinKe Xu, ShangYi Zhang
DOI: 10.1016/j.pjnns.2014.08.002
·
Neurol Neurochir Pol 2014;48(5):346-355.

open access

Vol 48, No 5 (2014)
Review article
Submitted: 2014-06-16

Abstract

Objective

The mortality of re-bleeding following aneurysmal subarachnoid hemorrhage is high, and surviving patients often have poor clinical condition and worse outcome than patients with a single bleed. In this study, we performed an updated systematic review and meta-analysis to determine the most common risk factors for re-bleeding in this patient population, with the goal of providing neurologists, neurosurgeons, neuro-interventionalists with a simple and fast method to evaluate the re-bleeding risk for aneurysmal subarachnoid hemorrhage.

Method

We conducted a thorough meta-analysis of the risk factors associated with re-bleeding or re-rupture of intracranial aneurysms in cases published between 2000 and 2013. Pooled mean difference was calculated for the continuous variables (age), and pooled odds ratio (OR) was calculated for categorical factors. If heterogeneity was significant (p<0.05), a random effect model was applied; otherwise, a fixed model was used. Testing for pooled effects and statistical significance for each potential risk factor were analyzed using Review Manager software.

Results

Our literature search identified 174 articles. Of these, only seven retrospective studies met the inclusion criteria. These seven studies consisted of 2470 patients, 283 of which had aneurysmal re-bleeding, resulting in a weighted average rate of re-bleeding of 11.3% with 95% confidence interval [CI]: 10.1–12.6. In this population, sex (OR 1.46; 95% CI: 1.11–1.92), high systolic blood pressure [SBP] (OR 2.52; 95% CI: 1.40–4.53), aneurysm size (OR 3.00; 95% CI: 2.06–4.37), clinical condition (Hunt & Hess) (OR 4.94; 95% CI: 2.29,10.68), and Fisher grade (OR 2.29; 95% CI: 1.45, 3.61) were statistically significant risk factors for re-bleeding.

Conclusion

Sex, high SBP, high Fisher grade, aneurysm size larger than 10mm, and poor clinical condition were independent risk factors for aneurysmal re-bleeding. The importance of early aneurysm intervention and careful consideration of patient risk factors should be emphasized to eliminate the risk of re-bleeding and poor outcome.

Abstract

Objective

The mortality of re-bleeding following aneurysmal subarachnoid hemorrhage is high, and surviving patients often have poor clinical condition and worse outcome than patients with a single bleed. In this study, we performed an updated systematic review and meta-analysis to determine the most common risk factors for re-bleeding in this patient population, with the goal of providing neurologists, neurosurgeons, neuro-interventionalists with a simple and fast method to evaluate the re-bleeding risk for aneurysmal subarachnoid hemorrhage.

Method

We conducted a thorough meta-analysis of the risk factors associated with re-bleeding or re-rupture of intracranial aneurysms in cases published between 2000 and 2013. Pooled mean difference was calculated for the continuous variables (age), and pooled odds ratio (OR) was calculated for categorical factors. If heterogeneity was significant (p<0.05), a random effect model was applied; otherwise, a fixed model was used. Testing for pooled effects and statistical significance for each potential risk factor were analyzed using Review Manager software.

Results

Our literature search identified 174 articles. Of these, only seven retrospective studies met the inclusion criteria. These seven studies consisted of 2470 patients, 283 of which had aneurysmal re-bleeding, resulting in a weighted average rate of re-bleeding of 11.3% with 95% confidence interval [CI]: 10.1–12.6. In this population, sex (OR 1.46; 95% CI: 1.11–1.92), high systolic blood pressure [SBP] (OR 2.52; 95% CI: 1.40–4.53), aneurysm size (OR 3.00; 95% CI: 2.06–4.37), clinical condition (Hunt & Hess) (OR 4.94; 95% CI: 2.29,10.68), and Fisher grade (OR 2.29; 95% CI: 1.45, 3.61) were statistically significant risk factors for re-bleeding.

Conclusion

Sex, high SBP, high Fisher grade, aneurysm size larger than 10mm, and poor clinical condition were independent risk factors for aneurysmal re-bleeding. The importance of early aneurysm intervention and careful consideration of patient risk factors should be emphasized to eliminate the risk of re-bleeding and poor outcome.

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Keywords

Cerebral aneurysm, Subarachnoid hemorrhage, Re-bleeding risk factor, Meta-analysis

About this article
Title

Risk factors for re-bleeding of aneurysmal subarachnoid hemorrhage: Meta-analysis of observational studies

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 48, No 5 (2014)

Pages

346-355

DOI

10.1016/j.pjnns.2014.08.002

Bibliographic record

Neurol Neurochir Pol 2014;48(5):346-355.

Keywords

Cerebral aneurysm
Subarachnoid hemorrhage
Re-bleeding risk factor
Meta-analysis

Authors

Gobran Taha Ahmed Alfotih
FangCheng Li
XinKe Xu
ShangYi Zhang

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