TY - JOUR
T1 - Unfavorable Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage WFNS Grade I
AU - Zijlmans, Jendé L.
AU - Coert, Bert A.
AU - van den Berg, René
AU - Sprengers, Marieke E. S.
AU - Majoie, Charles B. L. M.
AU - Vandertop, W. Peter
AU - Verbaan, Dagmar
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background: Patients with an aneurysmal subarachnoid hemorrhage (aSAH) and World Federation of Neurosurgical Societies (WFNS) grade I on admission are generally considered to have a good clinical outcome. Objective: The objective of this study was to assess the actual clinical outcome of WFNS grade I aSAH patients, and to determine which factors are associated with unfavourable outcome. Methods: For this prospective cohort study, 132 consecutive patients (age 18 years or older) with a WFNS grade I aSAH admitted to our hospital between December 2011 and January 2016 were eligible. Clinical outcome was measured using the modified Rankin Scale (mRS) at 6-month follow-up. Unfavorable outcome was defined as an mRS score of 3–6. Univariable analyses were performed using logistic regression models. Results: Of 116 patients, only 5 patients (4%) had an mRS score of 0 and most (65%) had an mRS score of 2. Twenty-five patients (22%) had an unfavorable outcome. Nine (8%) patients died, of whom 4 died during admission. Factors associated with unfavorable outcome were age (per increasing decade: odds ratio [OR]. 1.78; 95% confidence interval [CI], 1.16–2.72), delayed cerebral ischemia (OR, 4.32; 95% CI, 1.63–11.44), pneumonia (OR, 10.75; 95% CI, 1.94–59.46) and meningitis (OR, 28.47; 95% CI, 1.42–571.15). Conclusions: Despite their neurologically optimal clinical condition on admission, 1 in 5 patients with WFNS grade I aSAH has an unfavorable clinical outcome or is dead at 6-month follow-up. Additional multivariable analysis in larger patient cohorts is necessary to identify the extent to which preventable complications contribute to unfavorable outcomes in these patients.
AB - Background: Patients with an aneurysmal subarachnoid hemorrhage (aSAH) and World Federation of Neurosurgical Societies (WFNS) grade I on admission are generally considered to have a good clinical outcome. Objective: The objective of this study was to assess the actual clinical outcome of WFNS grade I aSAH patients, and to determine which factors are associated with unfavourable outcome. Methods: For this prospective cohort study, 132 consecutive patients (age 18 years or older) with a WFNS grade I aSAH admitted to our hospital between December 2011 and January 2016 were eligible. Clinical outcome was measured using the modified Rankin Scale (mRS) at 6-month follow-up. Unfavorable outcome was defined as an mRS score of 3–6. Univariable analyses were performed using logistic regression models. Results: Of 116 patients, only 5 patients (4%) had an mRS score of 0 and most (65%) had an mRS score of 2. Twenty-five patients (22%) had an unfavorable outcome. Nine (8%) patients died, of whom 4 died during admission. Factors associated with unfavorable outcome were age (per increasing decade: odds ratio [OR]. 1.78; 95% confidence interval [CI], 1.16–2.72), delayed cerebral ischemia (OR, 4.32; 95% CI, 1.63–11.44), pneumonia (OR, 10.75; 95% CI, 1.94–59.46) and meningitis (OR, 28.47; 95% CI, 1.42–571.15). Conclusions: Despite their neurologically optimal clinical condition on admission, 1 in 5 patients with WFNS grade I aSAH has an unfavorable clinical outcome or is dead at 6-month follow-up. Additional multivariable analysis in larger patient cohorts is necessary to identify the extent to which preventable complications contribute to unfavorable outcomes in these patients.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85050280194&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29966780
U2 - https://doi.org/10.1016/j.wneu.2018.06.157
DO - https://doi.org/10.1016/j.wneu.2018.06.157
M3 - Article
C2 - 29966780
SN - 1878-8750
VL - 118
SP - e217-e222
JO - World Neurosurgery
JF - World Neurosurgery
ER -