Factors Affecting Outcomes of Poor-Grade Subarachnoid Hemorrhage

Takao Sasaki; Masato Naraoka; Norihito Shimamura; Atsuto Takemura; Seiko Hasegawa; Kennichi Akasaka; Hiroki Ohkuma

doi:10.1016/j.wneu.2024.02.064

Factors Affecting Outcomes of Poor-Grade Subarachnoid Hemorrhage

World Neurosurg. 2024 Feb 19:S1878-8750(24)00261-4. doi: 10.1016/j.wneu.2024.02.064. Online ahead of print.

Authors

Takao Sasaki¹, Masato Naraoka², Norihito Shimamura³, Atsuto Takemura⁴, Seiko Hasegawa², Kennichi Akasaka⁵, Hiroki Ohkuma³

Affiliations

¹ Department of Neurosurgery, Hirosaki University, Hirosaki, Aomori, Japan. Electronic address: sasakisasaki@hirosaki-u.ac.jp.
² Department of Emergency, Disaster and General Medicine, Hirosaki University, Hirosaki, Aomori, Japan.
³ Department of Neurosurgery, Hirosaki General Medical Center, Hirosaki, Aomori, Japan.
⁴ Department of Neurosurgery, General Southern Tohoku Hospital, Iwanuma, Miyagi, Japan.
⁵ Department of Neurosurgery, Towada City Central Hospital, Towada, Aomori, Japan.

PMID: 38382759
DOI: 10.1016/j.wneu.2024.02.064

Abstract

Objective: Poor-grade subarachnoid hemorrhage (SAH) accounts for 20% of all SAH and is associated with poor outcomes. The first step in improving outcomes is to analyze the factors that contribute to poor outcomes.

Methods: This was a multicenter, retrospective, observational, cohort study. Data fields included demographic, clinical, radiological, and outcome data for all spontaneous patients with SAH treated at 4 hospitals in Aomori Prefecture in Japan. Patients with modified Rankin Scale score 0-2 at discharge were defined as the good outcome group, and those with modified Rankin Scale score 3-6 were defined as the poor outcome group, and comparisons were made between the 2 groups.

Results: There were 329 eligible patients with poor-grade SAH, 41 with good outcome group, and 288 with poor outcome group. On multivariate analysis of the outcome, conservative treatment (P < 0.001), Fisher group 4 (P < 0.007), age ≥65 years (P = 0.011), and Hunt and Kosnik grade V on admission (P = 0.021) were significant factors contributing to a poor outcome.

Conclusions: Nonelderly patients who are not in grade V and Fisher group 4 should undergo aneurysm treatment as soon as possible because they are more likely to have a good outcome, whereas elderly patients in grade V and Fisher group 4 are unlikely to benefit from aneurysm treatment at present. The development of a treatment for early brain injury may be important to improve the outcomes of patients with poor-grade SAH.

Keywords: Poor-grade SAH; Prognostic factors; Subarachnoid hemorrhage.