Spontaneous subarachnoid hemorrhage outcome

Spontaneous subarachnoid hemorrhage outcome

Currently, early prediction of outcome after spontaneous subarachnoid hemorrhage (SAH) lacks accuracy despite multiple studies addressing this issue.

Aneurysmal subarachnoid hemorrhage outcome

Kenya

Waveru et al., conducted a retrospective multicentre cross sectional studyinvolving patients admitted with SAH to three referral hospitals in Nairobi. All patients with a confirmed (primary) discharge diagnosis of first-time SAH between January 2009 and November 2017 were included (n = 158). Patients who had prior head trauma or cerebrovascular disease (n = 53) were excluded. Telephone interviews were conducted with surviving patients or their next of kin to assess out-of-hospital outcomes (including functional outcomes) based on modified Rankin Scale (mRS) scores. Chi-square and Fisher’s exact tests were used to assess associations between mortality and functional outcomes and sample characteristics.

Of the 158 patients sampled, 38 (24.1%) died in hospital and 42 (26.6%) died within 1 month. In total, 87 patients were discharged home and followed-up in this study, of which 72 reported favourable functional outcomes (mRS ≤2). This represented 45.6% of all patients who presented alive, pointing to high numbers of unfavourable outcomes post SAH in Kenya.

Mortality following SAH remains high in Kenya. Patients who survive the initial ictus tend to do well after treatment, despite resource constraints. : The study findings should be interpreted with caution because of unavoidable limitations in the primary data. These include its retrospective nature, the high number of patients lost to follow up, missing records and diagnoses, and/or possible miscoding of cases 1).

2014

In a multicenter, prospective and observational study. Including SAH admissions in ICU over 2014. Variables analized: epidemiological, cause of SAH, if aneurysmal SAH: aneurysm location and size, repair treatment; complications, ICU and hospital lenght of stay and morbidity (GOS scale).

Sample size: 127 patients. Epidemiology data: age 60,46 years (SD 12, 07), 54,33% women and risk factors: HBP 40,16%, dyslipidemia 22,05% and DM 6,30%. Severity scales: Hunt-Hess V: 23,62%, IV 13,39%; Fisher IV: 65,87 %, III 16,67 %; WFNS V: 22,83 %, IV 18,90%. Cause of SAH: 70,97% aneurysmal, 4,03% arteriovenous malformation (AVM) and 25% other. Aneurysm location: anterior comunicant 27,27%; posterior 21,21 %; middle cerebral artery 26,26 %. Aneurysmal sack diameter: small (< 15 mm) 67,05 %, large 22,73% and giant (>25 mm) 10,23%. Repair treatment: surgical 20,63%, endovascular (EVT) 39,68 % and conservative 39,68 %. Time admission-repairment: 3,5 days (SD 11,35), median 1 day (IQR 1). Complications: vasospasm 20,47 %, rebleeding 12,7%, delayed cerebral ischemia (DCI) 26,19%, hydrocephalus 31,75 %, seizures 7,14 %, ventriculitis 6,35% (22,86% with ventricular drainage), heart complications 15,87% and sodium disorders 20,47% (cerebral salt wasting 7,14%, SIADH 2,38% and diabetes insipidus 11,11%). Invasive monitoring: ICP 22,40% and PtiO2 6,60%. Median of length of stay: ICU 5 days (IQR 14) and hospital 15,5 days (IQR 22). Morbidity-GOS scale: 1 (death)= 23,39 % (51,72% donors); 2 = 3,23 %; 3 = 8,06 %; 4: 12,90%; 5: 52,42%.

The most common cause of SAH is cerebral aneurysm rupture with high Fisher. In this study the endovascular and conservative treatment are the same frequency greater than surgical. Maybe the severity of clinical presentation and high variability in the election of treatment among centers could influence. Time admission-repairment was near to recommendations. Results about complications and GOS scale are similar to the literature2).

References

1)

Waweru P, Gatimu SM. Mortality and functional outcomes after a spontaneous subarachnoid haemorrhage: A retrospective multicentre cross-sectional study in Kenya. PLoS One. 2019 Jun 12;14(6):e0217832. doi: 10.1371/journal.pone.0217832. eCollection 2019. PubMed PMID: 31188844.
2)

Iglesias Posadilla D, Gero Escapa M, González Robledo J, et al. Outcomes of spontaneous subarachnoid hemorrhage (sah) in neurocritical care unit: a multicenter study. Intensive Care Med Exp. 2015;3(Suppl 1):A773. Published 2015 Oct 1. doi:10.1186/2197-425X-3-S1-A773

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