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

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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 (P = 0.008 and P = 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.

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Acknowledgements

Funding: This study was funded from departmental sources (Assistance Publique-Hôpitaux de Paris).

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie-Paris 6 University, Paris, France

    Ana R. Pereira, Paola Sanchez-Peña, Chantal Colonne, Lise Lejean, Lamine Abdennour & Louis Puybasset

  2. Department of Neuroradiology, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie-Paris 6 University, Paris, France

    Alessandra Biondi & Nader Sourour

  3. Department of Neurosurgery, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie-Paris 6 University, Paris, France

    Anne L. Boch

  4. Département d’Anesthésie-Réanimation, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013, Paris, France

    Louis Puybasset

Authors
  1. Ana R. Pereira
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  2. Paola Sanchez-Peña
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  3. Alessandra Biondi
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  4. Nader Sourour
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  9. Louis Puybasset
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Correspondence to Louis Puybasset.

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Pereira, A.R., Sanchez-Peña, P., Biondi, A. et al. Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage. Neurocrit Care 7, 18–26 (2007). https://doi.org/10.1007/s12028-007-0053-5

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  • DOI: https://doi.org/10.1007/s12028-007-0053-5

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