Long-term Functional Outcomes for World Federation of Neurosurgical Societies Grade V Aneurysmal Subarachnoid Hemorrhage after Active Treatment

Abstract

This study investigated the long-term outcomes of patients with World Federation of Neurosurgical Societies (WFNS) grade V aneurysmal subarachnoid hemorrhage (SAH) who underwent early aneurysm repair. We evaluated consecutive patients with WFNS grade V aneurysmal SAH from April 2010 to March 2015 who underwent aneurysm repair within 72 h after onset. We assessed the functional outcomes at discharge and 3 years after onset using the modified Rankin Scale (mRS). The primary outcome was defined as a favorable functional outcome (mRS ≤2). We identified 145 patients with grade V SAH during the study period. Of these, 44 patients (19 males and 25 females; median age, 64 years; range, 24–79 years) met the inclusion criteria. For aneurysm repair, surgical clipping and coiling were performed in 40 (90.9%) and 4 (9.1%) patients, respectively. Although no patient had a favorable functional outcome at discharge, 11 (25.0%) patients had a favorable functional outcome at the end of follow-up. The number of patients with a favorable outcome significantly increased during the first year ( P = 0.012) and during the follow-up period ( P <0.001). Patients who underwent active rehabilitation had significant improvement. Our study showed that one-fourth of the patients who underwent early aneurysm repair with WFNS grade V SAH achieved a mRS score of ≤2 over a 3-year period. It might be important to consider age and rehabilitation for better clinical outcomes. Larger studies are required to adequately assess the long-term functional outcomes and other multi-faceted prognoses.

Findings Predictive of Poor Outcome in Grade 5 Subarachnoid Hemorrhage: A Cohort Study

“…46 Other studies have variably reported that high mean transit time on CT perfusion scans, evidence of early ischemic changes on CT angiography, absent corneal reflexes, and vasospasm-induced infarction are also highly predictive of poor outcome. 5,9,12,47 In keeping with our results, several studies indicate that even ominous admission characteristics, such as absent pupillary light reactivity or pre-hospital cardiac arrest, do not have sufficient PPV to predict hopeless outcome.…”

“…Patients were mechanically ventilated for a median of 7 (2-13) days. ICU and hospital (including in-patient neurorehabilitation) length of stay were 12 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) and 76 (26-118) days, respectively.…”

“…3 Grade 5 SAH is a life-threatening condition with high risk of death and long-term disability, but cohort studies have reported that a proportion of patients may ultimately achieve favorable outcomes. [4][5][6][7][8][9][10][11][12][13] Accurate and timely assessment of neurological prognosis, coupled with transparent conversations with patients' families, is a challenging, but necessary, aspect of providing critical care to patients with grade 5 SAH. If there is no realistic hope of favorable recovery, surgical intervention to treat the source of SAH will have limited benefit, and some patients may instead prefer (as expressed through an advanced directive or surrogate decision-maker) to transition to withdrawal of life-sustaining measures (WLSM).…”

Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage with World Federation of Neurological Societies grade V(OPAS-V)

“…10,13 Conversely, several reports have revealed that some of patients have good outcomes. 9,[11][12][13][14] It is still unclear which factors develops this heterogeneity in their outcomes. However, our decision tree model, OPAS-V, based on the routine examinations including laboratory findings at admission may be useful in identifying patients who need aggressive treatment.…”

“…10,11 Conversely, several reports have revealed that 14-25% of aggressively treated patients with WFNS grade V aSAH had good outcomes. 9,[11][12][13][14] The clinical severity of aSAH at admission has been reported to reflect the acute inflammatory response, including early brain injury (EBI). [15][16][17] In patients with WFNS grade V, the impact of EBI on their outcomes may be heterogeneous 16,18 and should be considered when developing outcome prediction models.…”