Key result
Excellent functional recovery occurs in ~63% of aSAH patients, linked to initial clinical condition and complications.
Why the study?
There is little information on predictors of excellent functional outcome after aneurysmal subarachnoid hemorrhage in the modern treatment era.
Cohort (n=373)
Excellent functional outcomes can be achieved in the majority of patients with aneurysmal subarachnoid hemorrhage, driven primarily by good initial clinical condition and the absence of complications such as intracerebral hemorrhage, infarction, and the need for blood transfusion.
May inform post-aSAH risk stratification; leaves open whether targeting modifiable predictors improves excellent outcomes.
OBJECT: Case fatality rates after aneurysmal subarachnoid hemorrhage (aSAH) have decreased over time, and many patients treated with modern paradigms return to a normal life. However, there is little information on predictors of excellent functional outcome after aSAH. In this study, the authors investigated predictors of excellent outcome in a modern consecutive series of patients with aSAH. METHODS: A retrospective review was conducted of patients with aSAH admitted between 2001 and 2013. The primary outcome measure was excellent functional outcome, defined as modified Rankin Scale (mRS) score of 0 or 1 at last follow-up within 1 year of aSAH. RESULTS: Three hundred seventy-three patients were identified with posthospital follow-up. Excellent outcome was noted in 236 patients (63.3%), including an mRS score of 0 in 122 (32.7%) and an mRS score of 1 in 114 (30.6%). On univariate analysis, the following factors were associated with an excellent outcome: indicators of less severe bleeding, such as better World Federation of Neurosurgical Societies grade at any of the times of assessment, better modified Fisher grade, and absence of intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH), and symptomatic hydrocephalus; aneurysm treatment with coil embolization; absence of symptomatic vasospasm, delayed cerebral ischemia, and radiological infarction; absence of in-hospital seizures; lack of need for CSF diversion; fewer hours with fever; less severe anemia; and absence of transfusion. On multivariable analysis, the 4 variables that were most strongly associated with excellent outcome were presence of good clinical grade after neurological resuscitation, absence of ICH on initial CT scan, blood transfusion during the hospitalization, and radiological infarctions on final brain imaging. CONCLUSIONS: Excellent outcomes (mRS score 0-1) can be achieved in the majority of patients with aSAH. The likelihood of excellent outcome is predicted by good clinical condition after resuscitation, absence of ICH on presentation, no evidence of infarction on brain imaging, and absence of blood transfusion during hospitalization.
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Pegoli et al. (2014) conducted a cohort in aneurysmal subarachnoid hemorrhage (n=373). Clinical and radiological predictors (e.g., good clinical grade, absence of ICH, no infarction, absence of blood transfusion) was evaluated on Excellent functional outcome (modified Rankin Scale score of 0 or 1 at last follow-up within 1 year). Excellent functional outcomes (mRS 0-1) were achieved in 63.3% of patients with aSAH and were predicted by good clinical condition, absence of ICH, no infarction, and no blood transfusion.
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