Trends in Mortality after Intensive Care of Patients with Aneurysmal Subarachnoid Hemorrhage in Finland in 2003–2019: A Finnish Intensive Care Consortium study

Abstract

Background Previous studies suggest that case mortality of aneurysmal subarachnoid hemorrhage (aSAH) has decreased during the last decades, but most studies have been unable to assess case severities among individual patients. We aimed to assess changes in severity-adjusted aSAH mortality in patients admitted to intensive care units (ICUs). Methods We conducted a retrospective, register-based study by using the prospectively collected Finnish Intensive Care Consortium database. Four out of five ICUs providing neurosurgical and neurointensive care in Finland participated in the Finnish Intensive Care Consortium. We extracted data on adult patients admitted to Finnish ICUs with aSAH between 2003 and 2019. The primary outcome was 12-month mortality during three periods: 2003–2008, 2009–2014, and 2015–2019. Using a multivariable logistic regression model—with variables including age, sex, World Federation of Neurological Surgeons grade, preadmission dependency, significant comorbidities, and modified Simplified Acute Physiology Score II—we analyzed whether admission period was independently associated with mortality. Results A total of 1,847 patients were included in the study. For the periods 2003–2008 and 2015–2019, the mean number of patients with aSAH admitted per year increased from 81 to 123. At the same time, the patients’ median age increased from 55 to 58 years (p = 0.001), and the proportion of patients with World Federation of Neurological Surgeons grades I–III increased from 42 to 58% (p < 0.001). The unadjusted 12-month mortality declined from 30% in 2003–2008 to 23% in 2015–2019 (p = 0.001), but there was no statistically significant change in severity-adjusted mortality. Conclusions Between 2003 and 2019, patients with aSAH admitted to ICUs became older and the proportion of less severe cases increased. Unadjusted mortality decreased but age and case severity adjusted–mortality remained unchanged.

Intensive Care Society State of the Art (SOA) 2023 Congress Abstracts

“…Patients who had a good outcome were also younger (p=0.006). Discussion/ Conclusion: This study confirms that SAH is associated with significant mortality and poor neurological outcomes if there is a need for ICU admission (Virta et al, 2021). Patients with poor outcomes were older and had significantly worse GCS on admission, with many having devastating brain injuries.…”

Case Fatality in Patients With Aneurysmal Subarachnoid Hemorrhage in Finland

“…Moreover, this may explain why a recent Finnish report with no age-specific or sex-specific analyses found a stable CFR trend among patients with SAH admitted to intensive care units. 38…”

“…Moreover, this may explain why a recent Finnish report with no age-specific or sex-specific analyses found a stable CFR trend among patients with SAH admitted to intensive care units. 38 This study has also limitations. First, although we were able to consider risk factor data through publicly available registers, we did not have patient-level data on risk factors of patients with SAH or in-hospital treatment modalities.…”

Sex-Related Differences in Mortality, Delayed Cerebral Ischemia, and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

“…Nineteen studies, referring to 18,534 patients with aSAH, were included in the metaanalysis (with 7067 male and 11,467 female patients) [12,13,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. Mortality was evaluated at different time points, from in-hospital mortality/mortality at the intensive care unit (ICU) to 12 months after aSAH.…”

“…The assessment of publication bias using a contourenhanced funnel plot indicated symmetry, and most of the data corresponded to points within the 95% CI, as shown in Figure 3. Comparison between male and female patients with aneurysmal subarachnoid hemorrhage [12,13,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. CI, confidence interval; RR, risk ratio.…”