BACKGROUND AND OBJECTIVES: The prognosis for functional independence after aneurysmal subarachnoid hemorrhage (aSAH) relies largely on patients' initial clinical status, age, and extent of the bleeding. However, some patients have poor outcome despite initially being in good clinical condition. The aim of this study was to analyze factors related to unfavorable outcome in patients with good clinical grade (World Federation of Neurosurgical Societies I-III) immediately before aneurysm treatment. METHODS: Prospectively gathered data of patients treated for aSAH in Sweden during the years 2014 to 2018 was analyzed. Preictal comorbidities, radiological findings, and aSAH-related and treatment-related adverse events (AEs) were analyzed using univariable and multivariable logistic regression. Outcome was assessed with Glasgow Outcome Scale Extended 1 year after the hemorrhage. RESULTS: One thousand thirty-seven patients were treated for aSAH, of whom 607 patients were in good clinical grade before aneurysm treatment. Clinical follow-up was obtained for 520 of these patients. At follow-up, 102 (20%) had an unfavorable outcome. Factors increasing the risk of unfavorable outcome in this subgroup were advanced age (odds ratio OR 1.05, 95% CI 1.03-1.07), hydrocephalus (OR 1.80, 95% CI 1.04-3.14), delayed ischemic neurological deficit (OR 3.43, 95% CI 1.96-6.00), and AEs during aneurysm occlusion (OR 2.38, 95% CI 1.30-4.38). CONCLUSION: Among patients with good clinical status (World Federation of Neurosurgical Societies I-III) before occlusion of the ruptured intracerebral aneurysm, 20% had unfavorable outcome after 1 year. Poor outcome was associated with age, complications resulting from the aSAH and AEs occurring during aneurysm occlusion.
Baldvinsdóttir et al. (Fri,) studied this question.