Factors associated with very poor outcome in patients with aneurysmal subarachnoid hemorrhage presenting with good clinical grade

Introduction Aneurysmal subarachnoid hemorrhage (aSAH) accounts for high morbidity and case-fatality. Although it is known that poor clinical status at the time of presentation is associated with poor outcome, even patients who arrive with a good neurological status may still experience unfavorable outcome. Research question Identifying factors associated with very poor outcomes in patients with good clinical condition at presentation. Methods We analyzed data from aSAH patients admitted between 2011 and 2021 from the Amsterdam UMC PROSAB registry and had available outcome information (596/672). All patients with World Federation of Neurosurgical Societies score 1-3 were included. Six-month outcomes were dichotomized in ‘good to moderate’ (modified Rankin Scale (mRS) score 0-4) and ‘very poor’ (mRS 5-6). Univariate and multivariable logistic regression analyses were performed to identify factors associated with very poor outcome. Results Fifty-nine patients (9.9%) had very poor outcome. In the univariate regression analysis, very poor outcome was significantly associated with age, aneurysm size, rebleeding, DCI, hydrocephalus, fever, pneumonia, seizures, meningitis, and sepsis. In the multivariable regression analysis, seizures [OR: 6.58, 95% CI (2.60, 16.62)], rebleeding [OR: 4.82, 95% CI (2.17, 10.69)], pneumonia [OR: 3.55, 95% CI (1.28, 9.88)], DCI [OR: 3.46, 95% CI (1.49, 8.05)], and aneurysm size [OR: 1.12, 95% CI (1.03, 1.22)] remained independently associated with very poor outcome. Discussion and Conclusion Seizures, rebleeding, pneumonia, DCI, and larger aneurysm size were independent predictors for very poor outcome. Prevention, detection and treatment of these complications are essential to improve prognosis even in initially well-presenting patients.