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Outcomes following poor-grade aneurysmal subarachnoid haemorrhage: a prospective observational study

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Abstract

Background

Up to 35% of aneurysmal subarachnoid haemorrhage (aSAH) cases may present as poor grade, defined as World Federation of Neurosurgical Societies (WFNS) grades IV and V. In this study, we evaluate functional outcomes and prognostic factors.

Methods

This prospective study included all patients referred to a national, centralized neurosurgical service with a diagnosis of poor-grade aSAH between 01/01/2016 and 31/12/2019. Multivariable logistic regression models were used to estimate probability of poor functional outcomes, defined as a Glasgow Outcome Scale (GOS) of 1–3 at 3 months.

Results

Two hundred fifty-seven patients were referred, of whom 116/257 (45.1%) underwent treatment of an aneurysm, with 97/116 (84%) treated within 48 h of referral. Median age was 62 years (IQR 51–69) with a female predominance (167/257, 65%). Untreated patients tended to be older; 123/141 (87%) had WFNS V, 60/141 (45%) unreactive pupils and 21/141 (16%) circulatory arrest. Of all referred patients, poor outcome occurred in 169/230 (73.5%). Unreactive pupils or circulatory arrest conferred a universally poor prognosis, with mortality in 55/56 (98%) and 19/19 (100%), respectively. The risk of a poor outcome was 14.1% (95% CI 4.5–23.6) higher in WFNS V compared with WFNS IV. Age was important in patients without circulatory arrest or unreactive pupils, with risk of a poor outcome increasing by 1.8% per year (95% CI 1–2.7). In patients undergoing aneurysm securement, 48/101 (47.5%) had a poor outcome, with age, rebleeding, vasospasm and cerebrospinal fluid (CSF) diversion being important prognosticators. The addition of serum markers did not add significant discrimination beyond the clinical presentation.

Conclusions

The overall outcomes of WFNS IV and V aSAH remain poor, mainly due to the devastating effects of the original haemorrhage. However, in patients selected for aneurysm securement, good outcomes can be achieved in more than half of patients. Age, pre-intervention rebleeding, vasospasm, and CSF diversion are important prognostic factors.

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References

  1. (1988) Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 68(6):985–986

  2. Alessandro O, Rene W, Stefan W, Miodrag F, Martin S, Oliver B, Urs P (2022) C-reactive protein elevation predicts in-hospital deterioration after aneurysmal subarachnoid hemorrhage: a retrospective observational study. Acta Neurochir (Wien) 164(7):1805–1814

    PubMed  Google Scholar 

  3. Al-Khindi T, Macdonald RL, Schweizer TA (2010) Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke 41(8):e519-536

    PubMed  Google Scholar 

  4. Al-Mufti F, Mayer SA, Kaur G et al (2021) Neurocritical care management of poor-grade subarachnoid hemorrhage: unjustified nihilism to reasonable optimism. Neuroradiol J 34(6):542–551

    PubMed  PubMed Central  Google Scholar 

  5. Ballarini NM, Chiu Y-D, König F, Posch M, Jaki T (2020) A critical review of graphics for subgroup analyses in clinical trials. Pharm Stat 19(5):541–560

    PubMed  PubMed Central  Google Scholar 

  6. Chen J, Zhu J, He J, Wang Y, Chen L, Zhang C, Zhou J, Yang L (2016) Ultra-early microsurgical treatment within 24 h of SAH improves prognosis of poor-grade aneurysm combined with intracerebral hematoma. Oncol Lett 11(5):3173–3178

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Choudhry A, Murray D, Corr P et al (2022) Timing of treatment of aneurysmal subarachnoid haemorrhage: are the goals set in international guidelines achievable? Ir J Med Sci 191(1):401–406

    PubMed  Google Scholar 

  8. Chu KH, Mahmoud I, Hou X-Y, Winter CD, Jeffree RL, Brown NJ, Brown AF (2018) Incidence and outcome of subarachnoid haemorrhage in the general and emergency department populations in Queensland from 2010 to 2014. Emerg Med Australas 30(4):503–510

    PubMed  Google Scholar 

  9. Connolly ES, Rabinstein AA, Carhuapoma JR et al (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 43(6):1711–1737

    PubMed  Google Scholar 

  10. Das KK, Singh S, Sharma P, Mehrotra A, Bhaisora K, Sardhara J, Srivastava AK, Jaiswal AK, Behari S, Kumar R (2017) Results of proactive surgical clipping in poor-grade aneurysmal subarachnoid hemorrhage: pattern of recovery and predictors of outcome. World Neurosurg 102:561–570

    PubMed  Google Scholar 

  11. de Oliveira Manoel AL, Mansur A, Silva GS et al (2016) Functional outcome after poor-grade subarachnoid hemorrhage: a single-center study and systematic literature review. Neurocrit Care 25(3):338–350

    PubMed  Google Scholar 

  12. de Winkel J, Cras TY, Dammers R, van Doormaal P-J, van der Jagt M, Dippel DWJ, Lingsma HF, Roozenbeek B (2022) Early predictors of functional outcome in poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. BMC Neurol 22(1):239

    PubMed  PubMed Central  Google Scholar 

  13. Doherty RJ, Henry J, Brennan D, Javadpour M (2022) Predictive factors for pre-intervention rebleeding in aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Neurosurg Rev 46(1):24

    PubMed  Google Scholar 

  14. Etminan N, Chang H-S, Hackenberg K, de Rooij NK, Vergouwen MDI, Rinkel GJE, Algra A (2019) Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol 76(5):588–597

    PubMed  PubMed Central  Google Scholar 

  15. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6(1):1–9

    CAS  PubMed  Google Scholar 

  16. Fukuda H, Hayashi K, Moriya T, Nakashita S, Lo BWY, Yamagata S (2015) Intrasylvian hematoma caused by ruptured middle cerebral artery aneurysms predicts recovery from poor-grade subarachnoid hemorrhage. J Neurosurg 123(3):686–692

    PubMed  Google Scholar 

  17. Gaastra B, Barron P, Newitt L, Chhugani S, Turner C, Kirkpatrick P, MacArthur B, Galea I, Bulters D (2021) CRP (C-reactive protein) in outcome prediction after subarachnoid hemorrhage and the role of machine learning. Stroke 52(10):3276–3285

    CAS  PubMed  Google Scholar 

  18. Goldberg J, Schoeni D, Mordasini P, Z’Graggen W, Gralla J, Raabe A, Beck J, Fung C (2018) Survival and outcome after poor-grade aneurysmal subarachnoid hemorrhage in elderly patients. Stroke 49(12):2883–2889

    PubMed  Google Scholar 

  19. Goldberg J, Z’Graggen WJ, Hlavica M et al (2023) Quality of life after poor-grade aneurysmal subarachnoid hemorrhage. Neurosurgery. https://doi.org/10.1227/neu.0000000000002332

    Article  PubMed  Google Scholar 

  20. Gusdon AM, Savarraj JPJ, Shihabeddin E, Paz A, Assing A, Ko S-B, McCullough LD, Choi HA (2021) Time course of peripheral leukocytosis and clinical outcomes after aneurysmal subarachnoid hemorrhage. Front Neurol 12:694996

    PubMed  PubMed Central  Google Scholar 

  21. Han Y, Ye F, Long X, Li A, Xu H, Zou L, Yang Y, You C (2018) Ultra-early treatment for poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. World Neurosurg 115:e160–e171

    PubMed  Google Scholar 

  22. Hanalioglu S, Sahin B, Sayyahmelli S, Ozaydin B, Erginoglu U, Aycan A, Baskaya MK (2022) The role of microsurgery for poor-grade aneurysmal subarachnoid hemorrhages in the endovascular era. Acta Neurochir (Wien) 164(3):781–793

    PubMed  Google Scholar 

  23. Heinze G, Wallisch C, Dunkler D (2018) Variable selection - A review and recommendations for the practicing statistician. Biom J 60(3):431–449

    PubMed  PubMed Central  Google Scholar 

  24. Hoogmoed J, van den Berg R, Coert BA, Rinkel GJE, Vandertop WP, Verbaan D (2017) A strategy to expeditious invasive treatment improves clinical outcome in comatose patients with aneurysmal subarachnoid haemorrhage. Eur J Neurol 24(1):82–89

    CAS  PubMed  Google Scholar 

  25. Hoogmoed J, Coert BA, van den Berg R, Roos YBWEM, Horn J, Vandertop WP, Verbaan D (2018) Early treatment decisions in poor-grade patients with subarachnoid hemorrhage. World Neurosurg 119:e568–e573

    PubMed  Google Scholar 

  26. Hoogmoed J, de Oliveira Manoel AL, Coert BA, Marotta TR, Macdonald RL, Vandertop WP, Verbaan D, Germans MR (2019) Why do patients with poor-grade subarachnoid hemorrhage die? World Neurosurg 131:e508–e513

    PubMed  Google Scholar 

  27. Hutchinson PJ, Power DM, Tripathi P, Kirkpatrick PJ (2000) Outcome from poor grade aneurysmal subarachnoid haemorrhage–which poor grade subarachnoid haemorrhage patients benefit from aneurysm clipping? Br J Neurosurg 14(2):105–109

    CAS  PubMed  Google Scholar 

  28. Inamasu J, Nakae S, Ohmi T et al (2016) The outcomes of early aneurysm repair in world federation of neurosurgical societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a glasgow coma scale score of 3. J Clin Neurosci 33:142–147

    PubMed  Google Scholar 

  29. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1(7905):480–484

    CAS  PubMed  Google Scholar 

  30. Kaneko J, Tagami T, Unemoto K et al (2019) Functional outcome following ultra-early treatment for ruptured aneurysms in patients with poor-grade subarachnoid hemorrhage. J Nippon Med Sch 86(2):81–90

    PubMed  Google Scholar 

  31. Kassell NF, Drake CG (1982) Timing of aneurysm surgery. Neurosurgery 10(4):514–519

    CAS  PubMed  Google Scholar 

  32. Kassell NF, Torner JC, Haley EC, Jane JA, Adams HP, Kongable GL (1990) The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results. J Neurosurg 73(1):18–36

    CAS  PubMed  Google Scholar 

  33. Korja M, Lehto H, Juvela S, Kaprio J (2016) Incidence of subarachnoid hemorrhage is decreasing together with decreasing smoking rates. Neurology 87(11):1118–1123

    PubMed  PubMed Central  Google Scholar 

  34. Kramer AH, Couillard PL, Kromm JA, Ruddell S, Demers-Marcil S, Mitha AP, Sutherland GR, Wong JH (2021) Findings predictive of poor outcome in grade 5 subarachnoid hemorrhage: a cohort study. Can J Neurol Sci 48(6):807–816

    PubMed  Google Scholar 

  35. Kranthi S, Sahu BP, Aniruddh P (2016) Factors affecting outcome in poor grade subarachnoid haemorrhage: an institutional study. Asian J Neurosurg 11(4):365–371

    PubMed  PubMed Central  Google Scholar 

  36. Krishnamurthi RV, Barker-Collo S, Parag V, Parmar P, Witt E, Jones A, Mahon S, Anderson CS, Barber PA, Feigin VL (2018) Stroke incidence by major pathological type and ischemic subtypes in the Auckland regional community stroke studies: changes between 2002 and 2011. Stroke 49(1):3–10

    PubMed  Google Scholar 

  37. Lashkarivand A, Sorteberg W, Rosseland LA, Sorteberg A (2020) Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5. Acta Neurochir (Wien) 162(3):533–544

    PubMed  Google Scholar 

  38. Le Roux PD, Elliott JP, Newell DW, Grady MS, Winn HR (1996) Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg 85(1):39–49

    PubMed  Google Scholar 

  39. Li P, Stuart EA, Allison DB (2015) Multiple imputation: a flexible tool for handling missing data. JAMA 314(18):1966–1967

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Li R, Lin F, Chen Y et al (2022) Elevated blood hemoglobin on admission as an independent predictor of unfavorable outcomes in patients with aneurysmal subarachnoid hemorrhage. Neurosurg Rev 45(4):2689–2699

    PubMed  Google Scholar 

  41. Li R, Zhao Y, Chen X, Hao Q (2022) Predictive values of white blood cell count in peripheral blood at admission on in-hospital complications and 90-day outcomes of patients with aneurysmal subarachnoid hemorrhage: insights from the LongTEAM Registry. J Inflamm Res 15:6481–6494

    PubMed  PubMed Central  Google Scholar 

  42. Lindbohm JV, Kaprio J, Jousilahti P, Salomaa V, Korja M (2017) Risk factors of sudden death from subarachnoid hemorrhage. Stroke 48(9):2399–2404

    PubMed  Google Scholar 

  43. Mack WJ, Hickman ZL, Ducruet AF et al (2008) Pupillary reactivity upon hospital admission predicts long-term outcome in poor grade aneurysmal subarachnoid hemorrhage patients. Neurocrit Care 8(3):374–379

    PubMed  Google Scholar 

  44. Mahta A, Azher AI, Moody S et al (2021) Association of Early white blood cell trend with outcomes in aneurysmal subarachnoid hemorrhage. World Neurosurg 151:e803–e809

    PubMed  Google Scholar 

  45. Newgard CD, Lewis RJ (2015) Missing data: how to best account for what is not known. JAMA 314(9):940–941

    CAS  PubMed  Google Scholar 

  46. Norton EC, Dowd BE, Maciejewski ML (2019) Marginal effects-quantifying the effect of changes in risk factors in logistic regression models. JAMA 321(13):1304–1305

    PubMed  Google Scholar 

  47. Post R, Germans MR, Tjerkstra MA et al (2021) Ultra-early tranexamic acid after subarachnoid haemorrhage (ULTRA): a randomised controlled trial. Lancet 397(10269):112–118

    CAS  PubMed  Google Scholar 

  48. Raabe A, Beck J, Goldberg J et al (2022) Herniation World Federation of Neurosurgical Societies scale improves prediction of outcome in patients with poor-grade aneurysmal subarachnoid hemorrhage. Stroke 53(7):2346–2351

    PubMed  Google Scholar 

  49. R Core Team (2022) R: a language and environment for statistical computing

  50. Ridwan S, Kristof R (2019) Cardiac arrest in patients with poor-grade aneurysmal subarachnoid hemorrhage: a single-center experience. J Neurol Surg A Cent Eur Neurosurg 80(6):409–412

    PubMed  Google Scholar 

  51. Roozenbeek B, Lingsma HF, Perel P, Edwards P, Roberts I, Murray GD, Maas AI, Steyerberg EW, IMPACT (International Mission on Prognosis and Clinical Trial Design in Traumatic Brain Injury) Study Group, CRASH (Corticosteroid Randomisation After Significant Head Injury) Trial Collaborators (2011) The added value of ordinal analysis in clinical trials: an example in traumatic brain injury. Crit Care 15(3):R127

    PubMed  PubMed Central  Google Scholar 

  52. Rordorf G, Ogilvy CS, Gress DR, Crowell RM, Choi IS (1997) Patients in poor neurological condition after subarachnoid hemorrhage: early management and long-term outcome. Acta Neurochir (Wien) 139(12):1143–1151

    CAS  PubMed  Google Scholar 

  53. Said M, Gümüs M, Rodemerk J et al (2022) Systematic review and meta-analysis of outcome-relevant anemia in patients with subarachnoid hemorrhage. Sci Rep 12(1):20738

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Schatlo B, Fung C, Stienen MN et al (2021) Incidence and outcome of aneurysmal subarachnoid hemorrhage: the Swiss study on subarachnoid hemorrhage (Swiss SOS). Stroke 52(1):344–347

    PubMed  Google Scholar 

  55. Sonne A, Bækgaard ES, Banner J, Rasmussen LS (2020) Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital death. J Stroke Cerebrovasc Dis 29(11):105239

    PubMed  Google Scholar 

  56. Sweeney K, Silver N, Javadpour M (2016) Subarachnoid haemorrhage (spontaneous aneurysmal). BMJ Clin Evid 2016:1213

    PubMed  PubMed Central  Google Scholar 

  57. Tasiou A, Brotis AG, Paschalis T, Tzerefos C, Kapsalaki EZ, Giannis T, Tzannis A, Fountas KN (2022) Intermediate surgical outcome in patients suffering poor-grade aneurysmal subarachnoid hemorrhage. A single center experience. Int J Neurosci 132(1):38–50

    PubMed  Google Scholar 

  58. Teo M, Guilfoyle MR, Turner C, Kirkpatrick PJ, Collaborators STASH (2017) What factors determine treatment outcome in aneurysmal subarachnoid hemorrhage in the modern era? A post hoc STASH analysis. World Neurosurg 105:270–281

    PubMed  Google Scholar 

  59. Turner CL, Budohoski K, Smith C, Hutchinson PJ, Kirkpatrick PJ, Murray GD, STASH collaborators, (2015) Elevated baseline C-reactive protein as a predictor of outcome after aneurysmal subarachnoid hemorrhage: data from the simvastatin in aneurysmal subarachnoid hemorrhage (STASH) trial. Neurosurgery 77(5):786–792 (discussion 792-793)

    PubMed  Google Scholar 

  60. Välimäki V, Luostarinen T, Satopää J, Raj R, Virta JJ (2021) Neurointensive care results and risk factors for unfavorable outcome in aneurysmatic SAH: a comparison of two age groups. Acta Neurochir (Wien) 163(5):1469–1478

    PubMed  Google Scholar 

  61. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative STROBE (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457

    Google Scholar 

  62. Wang X, Han C, Xing D, Wang C, Ding X (2019) Early management of poor-grade aneurysmal subarachnoid hemorrhage: a prognostic analysis of 104 patients. Clin Neurol Neurosurg 179:4–8

    PubMed  Google Scholar 

  63. Weir RU, Marcellus ML, Do HM, Steinberg GK, Marks MP (2003) Aneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system. AJNR Am J Neuroradiol 24(4):585–590

    PubMed  PubMed Central  Google Scholar 

  64. White P, Gregson B, McColl E, et al (2021) Emergent aneurysm treatment compared with treatment on neurological improvement in patients with ruptured poor-grade aneurysmal subarachnoid haemorrhage: the TOPSAT2 RCT. NIHR J Libr, Southampton (UK)

  65. Whitfield PC, Kirkpatrick PJ (2001) Timing of surgery for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2:CD001697

    Google Scholar 

  66. Wolfert C, Maurer CJ, Berlis A, Schneider H, Steininger K, Motov S, Krauss P, Sommer B, Shiban E (2022) Hydrocephalus, cerebral vasospasm, and delayed cerebral ischemia following non-aneurysmatic spontaneous subarachnoid hemorrhages: an underestimated problem. Neurosurg Rev 46(1):23

    PubMed  PubMed Central  Google Scholar 

  67. Wostrack M, Sandow N, Vajkoczy P et al (2013) Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile? Acta Neurochir (Wien) 155(4):579–586

    PubMed  Google Scholar 

  68. Zhao B, Zhao Y, Tan X, Cao Y, Wu J, Zhong M, Wang S (2015) Factors and outcomes associated with ultra-early surgery for poor-grade aneurysmal subarachnoid haemorrhage: a multicentre retrospective analysis. BMJ Open 5(4):e007410

    PubMed  PubMed Central  Google Scholar 

  69. Zheng K, Zhao B, Tan X-X, Li Z-Q, Xiong Y, Zhong M, Chen S-Y (2018) Comparison of aggressive surgical treatment and palliative treatment in elderly patients with poor-grade intracranial aneurysmal subarachnoid hemorrhage. Biomed Res Int 2018:5818937

    PubMed  PubMed Central  Google Scholar 

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Funding

The study was partially funded by Friends of A, a charitable organization.

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Authors and Affiliations

  1. National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland

    Jack Henry, Mohammed O. Dablouk, Dhruv Kapoor, Stavros Koustais, Paula Corr, Deirdre Nolan, Deirdre Coffey, Daniel Rawluk & Mohsen Javadpour

  2. Royal College of Surgeons in Ireland, Dublin, Ireland

    Jack Henry, Mohammed O. Dablouk, Stavros Koustais & Mohsen Javadpour

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

    John Thornton, Alan O’Hare & Sarah Power

  4. Department of Academic Neurology, Trinity College Dublin, Dublin, Ireland

    Mohsen Javadpour

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  1. Jack Henry
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Contributions

Concept and design: JH, MOD, MJ.

Acquisition of data: MOD, DK, PC, DN, DC, JT, AOH, SP, DR.

Interpretation of data: JH, MOD, MJ, JT, AOH, SP, DR.

Statistical analysis: JH.

Drafting of the manuscript: JH, MJ.

Critical revision of the manuscript for important intellectual content: all authors.

Supervision: MJ.

All authors reviewed the manuscript prior to final submission.

Corresponding authors

Correspondence to Jack Henry or Mohsen Javadpour.

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Ethical approval

This study was approved by the local institutional review board (CA248) and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants provided informed consent to all treatment.

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Henry, J., Dablouk, M.O., Kapoor, D. et al. Outcomes following poor-grade aneurysmal subarachnoid haemorrhage: a prospective observational study. Acta Neurochir 165, 3651–3664 (2023). https://doi.org/10.1007/s00701-023-05884-0

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