Pre-operative predictors and prognosticators after microsurgical clipping of poor grade subarachnoid hemorrhage: A retrospective study.

Pre-operative predictors and prognosticators after microsurgical clipping of poor grade subarachnoid hemorrhage: A retrospective study.

World Neurosurg. 2019 Feb 01;:

Authors: Ota N, Noda K, Hatano Y, Hashimoto A, Miyazaki T, Kondo T, Kinoshita Y, Kamiyama H, Tokuda S, Kamada K, Tanikawa R

Abstract
BACKGROUND: Contrary to expectations, some patients with poor grade subarachnoid hemorrhage (SAH) show favorable outcomes. However, the factors predictive of good prognosis are unclear. The purposes of this study were to identify factors related to poor grade SAH and to analyze pre-operative prognostic factors.
METHODS: We included 186 patients with SAH who underwent surgical clipping or conservative treatment immediately after SAH diagnosis. Physiological, radiographic, and blood examination data were collected retrospectively. Factors related to poor World Federation of Neurological Societies (WFNS) grade (WFNS IV and V) and poor outcome (modified Rankin Scale scores 3-6) were analyzed.
RESULTS: The subjects (mean age: 61.6 years) included 134 (72%) women. Seventy (38.2%) subjects had poor WFNS scores. On multivariate analysis, age ≥70 years (adjusted odds ratio [OR]: 3.73), midline shift (OR: 4.89), and the absence of cerebrospinal fluid in the high-convexity cortical sulci (OR: 5.47) and ambient cistern (OR: 4.83) were predictive of poor WFNS scores. Age ≥70 years (OR: 8.36), WFNS grade 5 (OR: 15.35), intracerebral hematoma (OR: 3.32), and Evans index (EI) ≥0.3 (OR: 4.40) were predictive of poor outcome. Body mass index (OR: 0.87), intraventricular hemorrhage (OR: 3.86), glycated hemoglobin level (OR: 2.78), and age ≥70 years (OR: 4.12) were predictive of EI ≥0.3.
CONCLUSIONS: Poor outcomes correlated with older age, brain-destructive hemorrhage, and EI ≥0.3. The EI reflects both hydrocephalus and the patient's frailty. Radiographic signs of poor grade SAH were not correlated with poor outcome, suggesting that early decompressive surgery may improve outcome.

PMID: 30716502 [PubMed - as supplied by publisher]

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