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A national cohort with aneurysmal subarachnoid hemorrhage: patient characteristics, choice of treatment, clinical outcome, and factors of prognostic importance
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.ORCID iD: 0000-0003-3354-4146
Department of Clinical Sciences - Neurosurgery, Lund University, Lund, Sweden.
Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
Department of Clinical Sciences, Linköping University, Linköping, Sweden.
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2024 (English)In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 190, p. e513-e524Article in journal (Refereed) Published
Abstract [en]

Objective: To study associations of clinical characteristics and treatment choice with functional outcome, mortality, and time to death in a national sample of aneurysmal subarachnoidal hemorrhage patients.

Methods: Data were extracted from a prospective nationwide multicenter study performed in September 2014 to March 2018. Glasgow Outcome Scale Extended (GOSE) grade, 1-year mortality, and survival probability were assessed at one year after ictus. Logistic univariate, multivariate, and Cox regression analyses were used to study the variables' associations with the outcomes.

Results: Unfavorable dichotomized GOSE (dGOSE; grades 1–4) was observed in 35.4% of patients. Microsurgery was preferred for middle cerebral artery aneurysms and Fisher grade 4. Treatment modality was not associated with any outcome measure. Dichotomized World Federation of Neurosurgical Societies (dWFNS), age, and delayed ischemic neurological deficit (DIND) showed significant correlations with dGOSE and 1-year mortality in multivariate regression analyses. Pupil dilatation was associated with a 1-year mortality outcome. Cox regression analysis showed lower survival probability for pupil dilatation (hazard ratio [HR]: 3.546), poor dWFNS (HR: 3.688), higher age (HR: 1.051), and DIND occurrence (HR: 2.214).

Conclusions: The patient selection in Sweden after aneurysmal subarachnoidal hemorrhage showed similar values for dGOSE, 1-year mortality, and survival probability between patients treated with microsurgery or endovascular technique. Poor dWFNS, higher age, and DIND were significantly associated with unfavorable dGOSE, mortality, and survival probability. Pupil dilatation was significantly associated with mortality and survival probability.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 190, p. e513-e524
Keywords [en]
Clipping, Coiling, Glasgow Outcome Scale Extended, Subarachnoid hemorrhage, WFNS
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-229572DOI: 10.1016/j.wneu.2024.07.164ISI: 001339033500001PubMedID: 39084286Scopus ID: 2-s2.0-85202039011OAI: oai:DiVA.org:umu-229572DiVA, id: diva2:1897823
Available from: 2024-09-16 Created: 2024-09-16 Last updated: 2025-04-24Bibliographically approved

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Aineskog, HelenaLindvall, Peter

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