open access

Vol 53, No 6 (2019)
Research Paper
Submitted: 2018-12-04
Accepted: 2019-09-25
Published online: 2019-10-28
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Predictors of unfavourable outcome in aneurysmal subarachnoid haemorrhage

Tijana Nastasovic1, Branko Milakovic12, Mila Stosic1, Jelena Eric Marinkovic2, Rosanda Ilic23, Mihailo Milicevic23, Irena Cvrkota23, Kristina Radinovic4, Olga Petrovic5, Danica Grujicic23
·
Pubmed: 31657445
·
Neurol Neurochir Pol 2019;53(6):421-427.
Affiliations
  1. Clinical Center of Serbia, Clinic for Neurosurgery, Department of Anesthesiology and Resuscitation, Pasterova 2, 11000 Belgrade, Serbia and Montenegro
  2. School of Medicine, University of Belgrade, Belgrade, Serbia and Montenegro
  3. Clinical Center of Serbia, Clinic for Neurosurgery, Pasterova 2, 11000 Belgrade, Serbia and Montenegro
  4. Clinical Center of Serbia, Clinic for Orthopedic Surgery, Department for Anesthesiology and Resuscitation, Pasterova 2, 11000 Belgrade, Serbia and Montenegro
  5. Clinical Center of Serbia, Clinic for Cardiology, Pasterova 2, 11000 Belgrade, Serbia and Montenegro

open access

Vol 53, No 6 (2019)
Research papers
Submitted: 2018-12-04
Accepted: 2019-09-25
Published online: 2019-10-28

Abstract

Background. Mortality rates following aneurysmal subarachnoid haemorrhage (aSAH) have decreased due to improvements in diagnoses and the management of complications, as well as early obliteration of the aneurysms. Neurogenic pulmonary oedema (NPO) is a clinical syndrome associated with an acute increase in intracranial pressure and a release of catecholamines into the circulation. This study investigated independent predictors of unfavourable outcomes (Glasgow Outcome Scores 1, 2 or 3) in patients with aSAH.

Materials and methods. A total of 262 patients with aSAH (162 females) were included in this prospective study. Clinical characteristics were assessed, and electrocardiographic, serum cardiac and inflammatory biomarker measurements were recorded on admission. Outcomes were assessed three months after admission. Univariate and multivariate analyses of these data were used to predict unfavourable outcomes.

Results. A total of 156 patients (59.54%) had unfavourable outcomes. Compared to those who had favourable outcomes, patients with unfavourable outcomes were significantly older (54.37 ± 10.56 vs. 49.13 ± 10.77 years; p < 0.001) and had more severe aSAHs (Hunt and Hess grades ≥ 3: 82.7% vs. 39.6%; p < 0.001). Patients with unfavourable outcomes were more likely to have NPO (10.3% vs. 2.8%; p = 0.023), hydrocephalus (34.0% vs. 20.8%; p = 0.02), and aneurysm reruptures (28.2% vs. 3.8%; p < 0.001).
Independent predictors of an unfavourable outcome included Hunt and Hess grades ≥ 3 (odds ratio [OR], 4.291; 95% confidence interval [CI], 2.168–8.491; p < 0.001), increased systolic blood pressure on admission (OR, 1.020; 95% CI, 1.002–1.038; p = 0.03), increased heart rate (HR) on admission (OR, 1.024; 95% CI, 1.001–1.048; p = 0.04), and aneurysm rerupture (OR, 4.961; 95% CI, 1.461–16.845; p = 0.01).

Conclusions. These findings suggest that aneurysm reruptures, as well as increased blood pressure and HR, are associated with unfavourable outcomes in patients with aSAH.

Abstract

Background. Mortality rates following aneurysmal subarachnoid haemorrhage (aSAH) have decreased due to improvements in diagnoses and the management of complications, as well as early obliteration of the aneurysms. Neurogenic pulmonary oedema (NPO) is a clinical syndrome associated with an acute increase in intracranial pressure and a release of catecholamines into the circulation. This study investigated independent predictors of unfavourable outcomes (Glasgow Outcome Scores 1, 2 or 3) in patients with aSAH.

Materials and methods. A total of 262 patients with aSAH (162 females) were included in this prospective study. Clinical characteristics were assessed, and electrocardiographic, serum cardiac and inflammatory biomarker measurements were recorded on admission. Outcomes were assessed three months after admission. Univariate and multivariate analyses of these data were used to predict unfavourable outcomes.

Results. A total of 156 patients (59.54%) had unfavourable outcomes. Compared to those who had favourable outcomes, patients with unfavourable outcomes were significantly older (54.37 ± 10.56 vs. 49.13 ± 10.77 years; p < 0.001) and had more severe aSAHs (Hunt and Hess grades ≥ 3: 82.7% vs. 39.6%; p < 0.001). Patients with unfavourable outcomes were more likely to have NPO (10.3% vs. 2.8%; p = 0.023), hydrocephalus (34.0% vs. 20.8%; p = 0.02), and aneurysm reruptures (28.2% vs. 3.8%; p < 0.001).
Independent predictors of an unfavourable outcome included Hunt and Hess grades ≥ 3 (odds ratio [OR], 4.291; 95% confidence interval [CI], 2.168–8.491; p < 0.001), increased systolic blood pressure on admission (OR, 1.020; 95% CI, 1.002–1.038; p = 0.03), increased heart rate (HR) on admission (OR, 1.024; 95% CI, 1.001–1.048; p = 0.04), and aneurysm rerupture (OR, 4.961; 95% CI, 1.461–16.845; p = 0.01).

Conclusions. These findings suggest that aneurysm reruptures, as well as increased blood pressure and HR, are associated with unfavourable outcomes in patients with aSAH.

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Keywords

subarachnoid hemorrhage, outcome, neurogenic pulmonary edema, hydrocephalus, rerupture

About this article
Title

Predictors of unfavourable outcome in aneurysmal subarachnoid haemorrhage

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 53, No 6 (2019)

Article type

Research Paper

Pages

421-427

Published online

2019-10-28

Page views

1925

Article views/downloads

454

DOI

10.5603/PJNNS.a2019.0051

Pubmed

31657445

Bibliographic record

Neurol Neurochir Pol 2019;53(6):421-427.

Keywords

subarachnoid hemorrhage
outcome
neurogenic pulmonary edema
hydrocephalus
rerupture

Authors

Tijana Nastasovic
Branko Milakovic
Mila Stosic
Jelena Eric Marinkovic
Rosanda Ilic
Mihailo Milicevic
Irena Cvrkota
Kristina Radinovic
Olga Petrovic
Danica Grujicic

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