Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Donkelaar, Carlina E. van; Bakker, Nicolaas A.; Veeger, Nic J. G. M.; Uyttenboogaart, Maarten; Metzemaekers, Jan D. M.; Luijckx, Gert-Jan; Groen, Rob J. M.; Dijk, J. Marc C. van

doi:10.1161/strokeaha.115.010037

Cited by 120 publications

(67 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Besides the association between mFisher grade and poor outcome because of the increased incidence of delayed cerebral ischemia, 5 the higher incidence of rebleeding in patients with a mFisher Grade 3 or 4 also might add to the increased risk. 22 In our study population, the percentage of patients with poor outcome may be considered relatively low 18 because of the inclusion of patients with perimesencephalic SAH. Also, in the 1990s, patients with SAH in very poor clinical condition were not always immediately referred to our hospital, leading to an underestimation of the true mortality rate, especially in Time Frame 1.…”

Section: Discussionmentioning

confidence: 99%

Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment

Donkelaar¹,

Bakker²,

Veeger³

et al. 2017

JNS

Self Cite

View full text Add to dashboard Cite

OBJECTIVE Currently, early prediction of outcome after spontaneous subarachnoid hemorrhage (SAH) lacks accuracy despite multiple studies addressing this issue. The clinical condition of the patient on admission as assessed using the World Federation of Neurosurgical Societies (WFNS) grading scale is currently considered the gold standard. However, the timing of the clinical assessment is subject to debate, as is the contribution of additional predictors. The aim of this study was to identify either the conventional WFNS grade on admission or the WFNS grade after neurological resuscitation (rWFNS) as the most accurate predictor of outcome after SAH. METHODS This prospective observational cohort study included 1620 consecutive patients with SAH admitted between January 1998 and December 2014 at our university neurovascular center. The primary outcome measure was a poor modified Rankin Scale score at the 2-month follow-up. Clinical predictors were identified using multivariate logistic regression analyses. Area under the receiver operating characteristic curve (AUC) analysis was used to test discriminative performance of the final model. An AUC of > 0.8 was regarded as indicative of a model with good prognostic value. RESULTS Poor outcome (modified Rankin Scale Score 4-6) was observed in 25% of the patients. The rWFNS grade was a significantly stronger predictor of outcome than the admission WFNS grade. The rWFNS grade was significantly associated with poor outcome (p < 0.001) as well as increasing age (p < 0.001), higher modified Fisher grade (p < 0.001), larger aneurysm size (p < 0.001), and the presence of an intracerebral hematoma (OR 1.8, 95% CI 1.2-2.8; p = 0.002). The final model had an AUC of 0.87 (95% CI 0.85-0.89), which indicates excellent prognostic value regarding the discrimination between poor and good outcome after SAH. CONCLUSIONS In clinical practice and future research, neurological assessment and grading of patients should be performed using the rWFNS to obtain the best representation of their clinical condition.

show abstract

Section: Discussionmentioning

confidence: 99%

Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment

Donkelaar¹,

Bakker²,

Veeger³

et al. 2017

JNS

Self Cite

View full text Add to dashboard Cite

show abstract

“…Imaging in the acute phase of SAH presentation may lead to better delineation of the early brain injury caused by SAH. However, MRI is usually not used in the acute phase of SAH as patients require critical care monitoring and MRI requires longer imaging time with minimal clinical monitoring (39, 40). …”

Section: Discussionmentioning

confidence: 99%

MRI Characterization in the Acute Phase of Experimental Subarachnoid Hemorrhage

Guo

Wilkinson

Thompson

et al. 2016

Transl. Stroke Res.

View full text Add to dashboard Cite

A number of mechanisms have been proposed for the early brain injury after subarachnoid hemorrhage (SAH). In this study, we investigated the radiographic characteristics and influence of gender on early brain injury after experimental SAH. SAH was induced by endovascular perforation in male and female rats. Magnetic resonance imaging was performed in a 7.0-T Varian MR scanner at 24 hours after SAH. The occurrence and size of T2 lesions, ventricular dilation and white matter injury (WMI) was determined on T2 weighted images (T2WI). The effects of SAH on heme oxygenase-1 and fibrin/fibrinogen were examined by Western blotting and immunohistochemistry. SAH severity was assessed using a MRI grading system and neurological function was evaluated according to a modified Garcia’s scoring system. T2-hyperintensity areas and enlarged ventricles were observed in T2WI coronal sections 24 hours after SAH. The overall incidence of T2-lesions, WMI and hydrocephalus was 54, 20 and 63%, respectively. Female rats had a higher incidence of T2-hyperintensity lesions and hydrocephalus, as well as larger T2 lesion volumes and higher average ventricular volume. SAH rats graded at 3-4 (our previously validated MRI grading scale) had larger T2 lesion volumes, more hydrocephalus and worse neurological function compared with those graded at 0-2. In conclusion, T2-lesion, WMI and hydrocephalus were the most prevalent MRI characteristics 24 hours after experimental SAH. The T2-lesion area matched with fibrinogen/fibrin positive staining in the acute phase of SAH. SAH induced more severe brain injury in females compared to males in the acute phase of SAH.

show abstract

“…There were some previous studies reporting that the risk factors of outcomes and complications of aSAH patients underwent EVT. 8,9 However, they either lacked comprehensive factors included or age stratification, which made them difficult to evaluate the risk of EVT for elderly aSAH patients comprehensively. 7,10,11 Hence, it is necessary to explore which factors are associated with poor outcome and develop a risk score specifically for elderly patients with aSAH receiving EVT that can be easily used in clinical practice and facilitate clinical decision-making process.…”

Section: Introductionmentioning

confidence: 99%

Prognosis Predicting Score for Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage

Duan

Yang

et al. 2016

Medicine

View full text Add to dashboard Cite

The elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have a greater risk of poor clinical outcome after endovascular treatment (EVT) than younger patients do. Hence, it is necessary to explore which factors are associated with poor outcome and develop a predictive score specifically for elderly patients with aSAH receiving EVT.The aim of this study was to develop and validate a predictive score for 1-year outcomes in individual elderly patients with aSAH underwent EVT.In this 10-year prospective study, 520 consecutive aSAH elderly (age ≥ 60 years) patients underwent EVT in a single center were included. The risk factors, periprocedural, and 1-year follow-up data of all patients were entered in a specific prospective database.The modified Rankin scale was used for evaluating clinical outcome. To optimize the model's predictive capacity, the original matrix was randomly divided in 2 submatrices (learning and testing). The predictive score was developed using Arabic numerals for all variables based on the variable coefficients (β) of multivariable logistic regression analysis in the learning set and the predictive performance evaluation was assessed in the testing set. The risk classes were constructed using classification criteria based on sensitivity and specificity.The poor outcome rate at 1 year was 26.15%. Six risk factors, including age, hypertension, Hunt–Hess scale, Fisher scale, aneurysm location, and periprocedural complications, were independently associated with poor outcome and assembled the Changhai score. The discriminative power analysis with the area under the receiver operating characteristic curve (AUC) of the Changhai score was statistically significant (0.864, 0.824–0.904, P < 0.001). The sensitivity and specificity of the Changhai score were 82.07% and 78.06%, respectively.Our study indicated that age, hypertension, Hunt–Hess scale, Fisher scale, aneurysm location, and periprocedural complications were independent risk factors of poor outcome for elderly aSAH patients underwent EVT. In combination with these risk factors, the Changhai score can be a useful tool in the prediction of clinical outcome but needs to be validated in various centers before it can be recommended for application.

show abstract

Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Cited by 120 publications

References 34 publications

Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment

Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment

MRI Characterization in the Acute Phase of Experimental Subarachnoid Hemorrhage

Prognosis Predicting Score for Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage

Contact Info

Product

Resources

About