Key result
Aneurysmal subarachnoid hemorrhage was associated with a 3.5 times increased mortality at 12-15 years post-ictus compared to matched controls (P < .0001).
Why the study?
What are the long-term functional outcomes and mortality rates 12-15 years after aneurysmal subarachnoid hemorrhage?
Cohort (n=158)
No
What are the long-term functional outcomes and mortality rates 12-15 years after aneurysmal subarachnoid hemorrhage?
Patients with aSAH have increased long-term mortality compared to matched controls, but those with favorable outcomes at 1 year have similar life expectancy to the general population and may continue to improve functionally.
May warrant extended surveillance in aSAH survivors; leaves open whether targeted interventions can reduce excess long-term mortality.
BACKGROUND: Patients with aneurysmal subarachnoid hemorrhage (aSAH) have poor outcome. Studies on outcome beyond 1 year post-aSAH are few, and late recovery is poorly investigated, initiating this prospective outcome study on patients 12-15 years after an aSAH. We hypothesized to find; functional improvement > 1 year post-ictus; increased long-term mortality in aSAH patients vs matched controls, and finally to present; predictors of long-term favorable outcome (GOS 4-5). METHODS: We prospectively investigated patients, admitted 2000-2003 to the Sahlgrenska University Hospital, 1 year post-ictus using Glasgow Outcome Scale (GOS). The patients were revalidated 12-15 years post-aSAH by structured-telephone interviews (GOS), followed by statistical analysis. RESULTS: A total of 158 patients were included, (women n = 114, men n = 44), with a mean age of 55 years at aSAH. Patients treated with surgical clipping had lower mortality. At the follow-up 12-15 years post-aSAH, all 103 survivors (65.2%) were categorized as having; good recovery (39.9%), moderate disability (15.2%), or severe disability (10.1%). Within the patient cohort, 23.6% improved GOS over time. Fifty-five patients died, median at 4 years post-ictus. aSAH patients had 3.5 times increased mortality 12-15 years post-ictus vs matched controls (P < .0001). Patients with favorable outcome at 1 year (67.3%, n = 101) had similar survival probability as control patients. Prognostic indicators of long-term favorable outcome were low age and high GOS at 1-year follow-up, (AUCROC, 0.79). CONCLUSIONS: Individual functional improvement was found >1 year post-ictus. Patients with favorable outcome at 1 year had similar long-term life expectancy as the general population. Indicators of long-term favorable prognosis were low age at ictus and high GOS at 1-year follow-up.
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Račkauskaitė et al. (2018) conducted a cohort in Aneurysmal subarachnoid hemorrhage (aSAH) (n=158). Aneurysmal subarachnoid hemorrhage vs. Matched controls was evaluated on Long-term mortality 12-15 years post-ictus (3.5 times increased mortality, p=< .0001). Aneurysmal subarachnoid hemorrhage was associated with a 3.5 times increased mortality at 12-15 years post-ictus compared to matched controls (P < .0001).
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