The role of previous medical history and secondary complications for the outcome of aneurysmal subarachnoid hemorrhage in elderly patients

Annika Lenkeit; Marvin Darkwah Oppong; Thiemo Florin Dinger; Meltem Gümüs; Jan Rodemerk; Mehdi Chihi; Yahya Ahmadipour; Anne-Kathrin Uerschels; Philipp Dammann; Cornelius Deuschl; Karsten H Wrede; Ulrich Sure; Ramazan Jabbarli

doi:10.1016/j.clineuro.2023.108027

The role of previous medical history and secondary complications for the outcome of aneurysmal subarachnoid hemorrhage in elderly patients

Clin Neurol Neurosurg. 2023 Dec:235:108027. doi: 10.1016/j.clineuro.2023.108027. Epub 2023 Oct 28.

Affiliations

¹ Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany. Electronic address: annika.lenkeit@uk-essen.de.
² Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
³ Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.

PMID: 37949039
DOI: 10.1016/j.clineuro.2023.108027

Abstract

Background: Aneurysmal subarachnoid hemorrhage (SAH) presents a devastating diagnosis for elderly individuals, resulting in high morbidity and mortality rates. The aim of the study was to analyze the impact of medical history and complications during SAH on the outcome of elderly patients.

Methods: Consecutive SAH cases aged ≥ 65 years old treated in our hospital between 01/2003 and 06/2016 were included (n = 218). Data on comorbidities, previous medication, initial severity, secondary complications, and the outcome were collected. Study endpoints were occurrence of cerebral infarcts, in-hospital mortality, and unfavorable outcome at 6 months after SAH.

Results: Cerebral infarcts were documented in 111 (51.2 % ) individuals. Multivariate analysis showed that angiographic vasospasm caused an increase (adjusted odds ratio [aOR] = 3.11, p = 0.022) in the risk of infarction, whereas aspirin treatment decreased (aOR = 0.25, p = 0.001) the risk of infarction. In turn, increasing age (aOR = 1.11, p = 0.002), intracranial hypertension (>20 mmHg, aOR = 3.32, p = 0.006) and acute kidney failure (aOR = 6.65, p = 0.035) during SAH were independently related to the risk of in-hospital mortality (n = 50; 22.9 % ). Finally, patients' age (aOR = 1.09, p = 0.022), high initial SAH burden (WFNS ≥ 4: aOR = 7.5, p < 0.0001; intraventricular hemorrhage: aOR = 4.38, p = 0.007), aneurysm clipping (aOR = 4.07, p = 0.018), and intracranial hypertension during SAH (aOR = 4.08, p = 0.006) were independent predictors of unfavorable outcome (n = 106/192; 55.5 % ). Previous medical history showed no negative impact on the severity, course and outcome of SAH.

Conclusion: About half of elderly SAH patients face poor outcomes after aneurysm securing. The initial severity of and complications during SAH are the major contributors to poor treatment results. Our findings might help to optimize the treatment strategies.

Keywords: Elderly patients; Medical history; Outcome predictors; SAH complications; Subarachnoid hemorrhage.

MeSH terms

Aged
Cerebral Infarction / complications
Humans
Intracranial Aneurysm* / complications
Intracranial Aneurysm* / surgery
Intracranial Hypertension* / complications
Medical History Taking
Subarachnoid Hemorrhage* / complications
Subarachnoid Hemorrhage* / therapy
Treatment Outcome