Neurocritical Care

, Volume 7, Issue 1, pp 18–26 | Cite as

Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage

  • Ana R. Pereira
  • Paola Sanchez-Peña
  • Alessandra Biondi
  • Nader Sourour
  • Anne L. Boch
  • Chantal Colonne
  • Lise Lejean
  • Lamine Abdennour
  • Louis Puybasset
Original Paper

Abstract

Objective

To describe features in patients admitted to the intensive care unit (ICU) for poor-grade aneurysmal subarachnoid hemorrhage (SAH) and to identify predictors of 12-month outcome.

Methods

We conducted a controlled observational study of 51 consecutive patients treated with endovascular coiling within 96 h of rupture for poor-grade aneurysmal SAH (20 men and 31 women, age 54 ± 12 years). We recorded co-morbidities; initial severity; aneurysm location; occurrence of acute hydrocephalus, initial seizures, and/or neurogenic lung edema; troponin values, Fisher grade; computed tomography (CT) findings; treatment intensity; and occurrence of vasospasm. The brain injury marker S100B was assayed daily over the first 8 days. Glasgow Outcome Scores (GOS) were recorded at ICU discharge, at 6 and 12 months. The main outcome criterion was the 1-year GOS score, which we used to classify patients as having a poor outcome (GOS 1–3) or a good outcome (GOS 4–5).

Results

Overall, clinical status after 1 year was very good (GOS 5) in 41% of patients and good (GOS 4) in 16%. Neither baseline characteristics nor interventions differed significantly between patients with good outcome (GOS 4–5) and those with poor outcome (GOS 1–3). Persistent intracranial pressure elevation and higher mean 8-day S100B value significantly and independently predicted the 1-year GOS outcome (= 0.008 and = 0.001, respectively).

Conclusions

Patients in poor clinical condition after SAH have more than a 50:50 chance of a favorable outcome after 1 year. High mean 8-day S100B value and persistent intracranial hypertension predict a poor outcome (GOS 1–3) after 1 year.

Keywords

Intracranial aneurysms Subarachnoid hemorrhage Poor-grade subarachnoid hemorrhage Coiling Outcome 

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Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Ana R. Pereira
    • 1
  • Paola Sanchez-Peña
    • 1
  • Alessandra Biondi
    • 2
  • Nader Sourour
    • 2
  • Anne L. Boch
    • 3
  • Chantal Colonne
    • 1
  • Lise Lejean
    • 1
  • Lamine Abdennour
    • 1
  • Louis Puybasset
    • 1
    • 4
  1. 1.Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de ParisPierre and Marie Curie-Paris 6 UniversityParisFrance
  2. 2.Department of Neuroradiology, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de ParisPierre and Marie Curie-Paris 6 UniversityParisFrance
  3. 3.Department of Neurosurgery, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de ParisPierre and Marie Curie-Paris 6 UniversityParisFrance
  4. 4.Département d’Anesthésie-RéanimationHôpital de la Pitié-SalpêtrièreParisFrance

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