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Predictive factors for pre-intervention rebleeding in aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis

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Abstract

Rebleeding before intervention is a devastating complication of aneurysmal subarachnoid haemorrhage (aSAH). It often occurs early and is associated with poor outcomes. We present a systematic review and meta-analysis to identify potential predictors of rebleeding in aSAH. A database search identified studies detailing the occurrence of pre-intervention rebleeding in aSAH, and 809 studies were screened. The association between rebleeding and a variety of demographic, clinical, and radiological factors was examined using random effects meta-analyses. Fifty-six studies totalling 33,268 patients were included. Rebleeding occurred in 3,223/33,268 patients (11.1%, 95%CI 9.4–13), with risk decreasing by approximately 0.2% per year since 1981. Systolic blood pressure (SBP) during admission was higher in patients who rebled compared with those who did not (MD 7.4 mmHg, 95%CI 2.2 – 12.7), with increased risk in cohorts with SBP > 160 mmHg (RR 2.12, 95%CI 1.35–3.34), but not SBP > 140 mmHg. WFNS Grades IV–V (RR 2.05, 95%CI 1.13–3.74) and Hunt-Hess grades III–V (RR 2.12, 95%CI 1.38–3.28) were strongly associated with rebleeding. Fisher grades IV (RR 2.24, 95%CI 1.45–3.49) and III–IV (RR 2.05, 95%CI 1.17–3.6) were also associated with an increased risk. Awareness of potential risk factors for rebleeding is important when assessing patients with aSAH to ensure timely management in high-risk cases. Increased SBP during admission, especially > 160 mmHg, poorer clinical grades, and higher radiological grades are associated with an increased risk. These results may also aid in designing future studies assessing interventions aimed at reducing the risk of rebleeding.

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Supplementary digital content is available which details the search string used to identify articles that were considered for inclusion. All extracted data is available within the full texts of referenced articles.

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Authors and Affiliations

  1. National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland

    Ronan J. Doherty, Jack Henry & Mohsen Javadpour

  2. Royal College of Surgeons in Ireland, St. Stephen’s Green, Dublin, Ireland

    Ronan J. Doherty, Jack Henry & Mohsen Javadpour

  3. Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland

    David Brennan

  4. School of Medicine, Trinity College Dublin, Dublin, Ireland

    Mohsen Javadpour

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  2. Jack Henry
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RD: conceptualisation, methodology, literature screening, literature review, formal analysis, writing, and revision.

JH: methodology, formal analysis, writing, revision.

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MJ: conceptualisation, methodology, manuscript review and editing, and supervision.

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Doherty, R.J., Henry, J., Brennan, D. et al. Predictive factors for pre-intervention rebleeding in aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Neurosurg Rev 46, 24 (2023). https://doi.org/10.1007/s10143-022-01930-0

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