Can Neurological Characteristics and Comorbidities Predict Early Mortality of Non-traumatic Sub-arachnoid Hemorrhage?

Background: Non-traumatic subarachnoid hemorrhage (SAH) is a severe cerebrovascular emergency with a high early mortality rate due to risks of neurological deterioration, rebleeding, and elevated intracranial pressure. Prognosis largely depends on hemorrhage severity and level of consciousness at presentation. Identifying predictors of early mortality is crucial for timely intervention. Objectives: This study evaluated the clinical and demographic predictors of 24-hour and in-hospital mortality in patients with non-traumatic SAH and identify high-risk profiles. Materials & Methods: A retrospective study of 174 adults diagnosed with non-traumatic SAH between March 2020 and February 2024 was conducted. Data on demographics, comorbidities, presenting symptoms, imaging findings, and neurological scores (Glasgow coma scale [GCS], Hunt–Hess grade, modified Rankin scale [MRS]) were collected. Univariate and multivariate logistic regression analyses identified independent predictors of 24-hour and in-hospital mortality. Results: Early (24-hour) mortality occurred in 3.4% of patients, and overall, in-hospital mortality was 35.6%. Higher SAH grades and lower GCS scores were strongly associated with mortality. Each additional GCS point reduced the odds of 24-hour death by 43% (OR=0.57, P<0.001), while higher SAH grade increased the risk of mortality. Age was inversely correlated with early mortality but increased overall in-hospital mortality risk. Hypertension independently raised the odds of in-hospital death (OR=3.3, P=0.021). Other comorbidities and demographics were not significant predictors after adjustment. Conclusion: GCS and SAH grade at admission are the strongest predictors of early mortality in non-traumatic SAH. Comorbidities play a secondary role. Early identification of high-risk patients and prompt targeted management may reduce preventable deaths, particularly in resource-limited settings.