Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage

Stienen, Martin N.; Germans, Menno R.; Burkhardt, Jan‐Karl; Neidert, Marian C.; Fung, Christian; Bervini, David; Zumofen, Daniel; Röthlisberger, Martina; Marbacher, Serge; Maduri, Rodolfo; Robert, Thomas; Seule, Martin; Schaller, Karl; Fandiño, Javier; Smoll, Nicolas R.; Maldaner, Nicolai; Finkenstädt, Sina; Esposito, Giuseppe; Schatlo, Bawarjan; Keller, Emanuela; Bozinov, Oliver; Regli, Luca

doi:10.1161/strokeaha.117.019328

Cited by 117 publications

(57 citation statements)

References 47 publications

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“…However, in aSAH, pupil status in particular has rarely been integrated in prognostic models and grading systems even though it represents an easy assessable feature and pupil reactivity has already been associated with long-term outcome in poor-grade aSAH patients 22 . Moreover, pupil dilation at admission was a predictor of in-hospital mortality in an univariate analysis of the Swiss Study on Aneurysmal Subarachnoid Hemorrhage database 23 .…”

Section: Discussionmentioning

confidence: 99%

Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Mader

Piffko

Dengler

et al. 2020

Sci Rep

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Prognosis of patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH) is onlyinsufficiently displayed by current standard prognostic scores. This study aims to evaluate the role of pupil status for mortality prediction and provide improved prognostic models. Anonymized data of 477 aSAH patients admitted to our medical center from November 2010 to August 2018 were retrospectively analyzed. Identification of variables independently predicting in-hospital mortality was performed by multivariable logistic regression analysis. Final regression models included Hunt & Hess scale (H&H), pupil status and age or in a simplified variation only H&H and pupil status, leading to the design of novel H&H-Pupil-Age score (HHPA) and simplified H&H-Pupil score (sHHP), respectively. In an external validation cohort of 402 patients, areas under the receiver operating characteristic curves (AUROC) of HHPA (0.841) and sHHP (0.821) were significantly higher than areas of H&H (0.794; p < 0.001) or World Federation of Neurosurgical Societies (WFNS) scale (0.775; p < 0.01). Accordingly, including information about pupil status improves the predictive performance of prognostic scores for in-hospital mortality in patients with aSAH. HHPA and sHHP allow simple, early and detailed prognosis assessment while predictive performance remained strong in an external validation cohort suggesting adequate generalizability and low interrater variability.

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Section: Discussionmentioning

confidence: 99%

Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Mader

Piffko

Dengler

et al. 2020

Sci Rep

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“…Rebleeding prior to aneurysm repair is a serious complication of SAH [46]. Meta-analysis of 14 studies including 5693 patients reported rebleeding in 7-26% of patients (mean 13%) [47], with the majority occurring within 3 days of the initial bleed regardless of aneurysm size [48].…”

Section: Rebleedingmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage: the Last Decade

Neifert

Chapman

Martini

et al. 2020

Transl. Stroke Res.

245

170

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Aneurysmal subarachnoid hemorrhage (SAH) affects six to nine people per 100,000 per year, has a 35% mortality, and leaves many with lasting disabilities, often related to cognitive dysfunction. Clinical decision rules and more sensitive computed tomography (CT) have made the diagnosis of SAH easier, but physicians must maintain a high index of suspicion. The management of these patients is based on a limited number of randomized clinical trials (RCTs). Early repair of the ruptured aneurysm by endovascular coiling or neurosurgical clipping is essential, and coiling is superior to clipping in cases amenable to both treatments. Aneurysm repair prevents rebleeding, leaving the most important prognostic factors for outcome early brain injury from the hemorrhage, which is reflected in the neurologic condition of the patient, and delayed cerebral ischemia (DCI). Observational studies suggest outcomes are better when patients are managed in specialized neurologic intensive care units with inter-or multidisciplinary clinical groups. Medical management aims to minimize early brain injury, cerebral edema, hydrocephalus, increased intracranial pressure (ICP), and medical complications. Management then focuses on preventing, detecting, and treating DCI. Nimodipine is the only pharmacologic treatment that is approved for SAH in most countries, as no other intervention has demonstrated efficacy. In fact, much of SAH management is derived from studies in other patient populations. Therefore, further study of complications, including DCI and other medical complications, is needed to optimize outcomes for this fragile patient population.

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“…The complications of aSAH include rebleeding, DCI, hydrocephalus, increased intracranial pressure, and seizures ( 97 ). Previous studies have highlighted rebleeding and DCI, which contribute to high rates of disability and neurological dysfunction in survivors and are independent predictors of unfavorable outcomes ( 98 ).…”

Section: Practice Prospectsmentioning

confidence: 99%

The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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Aneurysmal subarachnoid hemorrhage (aSAH) is an important type of stroke with the highest rates of mortality and disability. Recent evidence indicates that neuroinflammation plays a critical role in both early brain injury and delayed neural deterioration after aSAH, contributing to unfavorable outcomes. The neutrophil-to-lymphocyte ratio (NLR) is a peripheral biomarker that conveys information about the inflammatory burden in terms of both innate and adaptive immunity. This review summarizes relevant studies that associate the NLR with aSAH to evaluate whether the NLR can predict outcomes and serve as an effective biomarker for clinical management. We found that increased NLR is valuable in predicting the clinical outcome of aSAH patients and is related to the risk of complications such as delayed cerebral ischemia (DCI) or rebleeding. Combined with other indicators, the NLR provides improved accuracy for predicting prognosis to stratify patients into different risk categories. The underlying pathophysiology is highlighted to identify new potential targets for neuroprotection and to develop novel therapeutic strategies.

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Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage

Abstract: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03245866.

Cited by 117 publications

References 47 publications

Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Aneurysmal Subarachnoid Hemorrhage: the Last Decade

The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage

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