The Effects of Fluid Balance and Colloid Administration on Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Propensity Score-Matched Analysis
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Delayed ischemic neurological deficit (DIND) following aneurysmal subarachnoid hemorrhage (SAH) remains a significant cause of mortality and disability. The administration of colloids and the induction of a positive fluid balance during the vasospasm risk period remain controversial. Here, we compared DIND and outcomes among propensity score-matched cohorts who did and did not receive colloids and also tested the effect of a positive fluid balance on these endpoints.
Exploratory analysis was performed on 413 patients enrolled in CONSCIOUS-1, a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm. Propensity score matching was performed on the basis of age, gender, pre-existing heart conditions, hypertension, nicotine use, World Federation of Neurosurgical Societies scores, aneurysm location, clazosentan treatment, subarachnoid clot burden, and severity of angiographic vasospasm. Inferential statistics were used for group-wise comparisons.
One hundred twenty-three subjects were matched (41 received colloids, whereas 82 did not). The covariate balance and propensity score distributions were acceptable. There was no difference between the groups with respect to DIND (17 vs. 22 %; p = 0.64) or the presence (48 vs. 51 %; p = 0.71) or volume of delayed infarcts (volume >7.5 cm3; 62 vs. 48 %; p = 0.41). Similarly, no differences were found on multivariate analysis between patients who did and did not have a positive fluid balance, although patients with severe angiographic vasospasm had more delayed infarcts with a negative fluid balance (p = 0.01). Among all subjects, the administration of colloids and a positive fluid balance were associated with worse outcomes on the NIHSS (p = 0.04) and modified Rankin (p = 0.02) scales, respectively.
Colloid administration and induction of a positive fluid balance during the vasospasm risk period may be associated with poor outcomes in specific patient groups. Patient selection is of utmost importance when managing the fluid status of patients with aneurysmal SAH.
KeywordsHemodynamic therapy HHH Fluid balance Subarachnoid hemorrhage Triple-H Vasospasm Volume expansion
Anterior cerebral artery
Delayed ischemic neurological deficit
Extended glasgow outcome scale
Triple-H (hypertension, hypervolemia, hemodilution)
Internal carotid artery
Middle cerebral artery
Modified rankin scale
National Institutes of Health Stroke Scale
World Federation of Neurosurgical Societies
Actelion Pharmaceuticals, Ltd., was the sponsor of the CONSCIOUS-1 trial; the company provided the authors with the trial dataset, but had no role in this exploratory analysis nor the development of the article. The data analysis and writing are the work of the authors. R. Loch Macdonald is a chief scientific officer at Edge Therapeutics, Inc.
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