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Nguyen TA, Vu LD, Mai TD, Dao CX, Ngo HM, Hoang HB, Do SN, Nguyen HT, Pham DT, Nguyen MH, Nguyen DN, Vuong HTT, Vu HD, Nguyen DD, Nguyen LQ, Dao PV, Vu TD, Nguyen DT, Tran TA, Pham TQ, Van Nguyen C, Nguyen AD, Luong CQ. Predictive validity of the prognosis on admission aneurysmal subarachnoid haemorrhage scale for the outcome of patients with aneurysmal subarachnoid haemorrhage. Sci Rep 2023; 13:6721. [PMID: 37185953 PMCID: PMC10130082 DOI: 10.1038/s41598-023-33798-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
This multicentre prospective cohort study aimed to compare the accuracy of the PAASH, WFNS, and Hunt and Hess (H&H) scales in predicting the outcomes of adult patients with aneurysmal SAH presented to three central hospitals in Hanoi, Vietnam, from August 2019 to June 2021. Of 415 eligible patients, 32.0% had a 90-day poor outcome, defined as an mRS score of 4 (moderately severe disability) to 6 (death). The PAASH, WFNS and H&H scales all have good discriminatory abilities for predicting the 90-day poor outcome. There were significant differences in the 90-day mean mRS scores between grades I and II (p = 0.001) and grades II and III (p = 0.001) of the PAASH scale, between grades IV and V (p = 0.026) of the WFNS scale, and between grades IV and V (p < 0.001) of the H&H scale. In contrast to a WFNS grade of IV-V and an H&H grade of IV-V, a PAASH grade of III-V was an independent predictor of the 90-day poor outcome. Because of the more clearly significant difference between the outcomes of the adjacent grades and the more strong effect size for predicting poor outcomes, the PAASH scale was preferable to the WFNS and H&H scales.
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Affiliation(s)
- Tuan Anh Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong Road, Phuong Mai Ward, Dong Da District, Hanoi, 100000, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Luu Dang Vu
- Radiology Centre, Bach Mai Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ton Duy Mai
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Stroke Center, Bach Mai Hospital, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Co Xuan Dao
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - Hung Manh Ngo
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
- Department of Neurosurgery II, Neurosurgery Center, Vietnam-Germany Friendship Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Bui Hoang
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Son Ngoc Do
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - Hao The Nguyen
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Neurosurgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Dung Thi Pham
- Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - My Ha Nguyen
- Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Duong Ngoc Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong Road, Phuong Mai Ward, Dong Da District, Hanoi, 100000, Vietnam
| | - Hien Thi Thu Vuong
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Emergency Department, Vietnam-Czechoslovakia Friendship Hospital, Hai Phong, Vietnam
| | - Hung Dinh Vu
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Dong Duc Nguyen
- Department of Neurosurgery II, Neurosurgery Center, Vietnam-Germany Friendship Hospital, Hanoi, Vietnam
| | - Linh Quoc Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong Road, Phuong Mai Ward, Dong Da District, Hanoi, 100000, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Phuong Viet Dao
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Stroke Center, Bach Mai Hospital, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Thanh Dang Vu
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Emergency Department, Agriculture General Hospital, Hanoi, Vietnam
| | | | - Tuan Anh Tran
- Radiology Centre, Bach Mai Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Trang Quynh Pham
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
- Department of Neurosurgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong Road, Phuong Mai Ward, Dong Da District, Hanoi, 100000, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Anh Dat Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong Road, Phuong Mai Ward, Dong Da District, Hanoi, 100000, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong Road, Phuong Mai Ward, Dong Da District, Hanoi, 100000, Vietnam.
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
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2
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Fernandez-Perez I, Giralt-Steinhauer E, Cuadrado-Godia E, Guimaraens L, Vivas E, Saldaña J, Suárez-Pérez A, Macias-Gomez A, Revert-Barbera A, Estragues-Gazquez I, Rodríguez-Campello A, Jiménez-Balado J, Rey-Álvarez L, Roquer J, Jimenez-Conde J, Ois A. Long-term vascular events after subarachnoid hemorrhage. J Neurol 2022; 269:6036-6042. [PMID: 35854138 DOI: 10.1007/s00415-022-11255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spontaneous subarachnoid hemorrhage (SAH) long-term risk is not well known. Our aims are: describing long-term vascular event (VE) incidence rates in SAH survivors; describing VE: ischemic and/or hemorrhagic; identifying independent association of factors related to VE; and analyzing the usefulness of factors to increase predictive ability. METHODS A prospective cohort study of consecutive patients admitted to Hospital del Mar with a diagnosis of SAH (n = 566) between January 2007 and January 2020 was carried out. They were followed up until January 2021. The study endpoint was a new VE in the follow-up. We calculated both incidence rates and cumulative rates at 5 years. Cox regression survival models including vascular risk factors with and without specific data of SAH disease were developed. We analyzed ROC curves of all multivariate models. RESULTS The analyzed cohort included 423 non-fatal SAH cases. Total patient-years were 2468.16 years. The average follow-up was 70.03 ± 43.14; range: 1-180 months. There were 49 VE detected in 47 patients, as 2 of them had more than 1 VE. Incidence rate was 0.020 events_per_patient/year, cumulative incidence at 5 years was 11.11%. The more frequent VE that we found were cerebrovascular (28/49), mainly ischemic (21/28). Disability after SAH and the presence of multiple aneurysms were independently associated with a VE risk and improved the predictive capacity of multivariate models (AUC 0.679 vs 0.764; p = 0.0062). CONCLUSIONS We reported a low vascular risk after SAH. We have shown the usefulness of SAH factors to identify patients with a higher risk of VE.
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Affiliation(s)
- Isabel Fernandez-Perez
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Eva Giralt-Steinhauer
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain. .,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. .,Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Elio Vivas
- Departament J Merland de Neuroangiografia Terapèutica, Barcelona, Spain
| | - Jesus Saldaña
- Departament J Merland de Neuroangiografia Terapèutica, Barcelona, Spain
| | - Antoni Suárez-Pérez
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Adria Macias-Gomez
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Anna Revert-Barbera
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | | | - Ana Rodríguez-Campello
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Jaume Roquer
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Jimenez-Conde
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Angel Ois
- Neurology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Barcelona, Spain
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3
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Luong CQ, Ngo HM, Hoang HB, Pham DT, Nguyen TA, Tran TA, Nguyen DN, Do SN, Nguyen MH, Vu HD, Vuong HTT, Mai TD, Nguyen AQ, Le KH, Dao PV, Tran TH, Vu LD, Nguyen LQ, Pham TQ, Dong HV, Nguyen HT, Nguyen CV, Nguyen AD. Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study. PLoS One 2021; 16:e0256150. [PMID: 34388213 PMCID: PMC8362943 DOI: 10.1371/journal.pone.0256150] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of risk factors for poor outcomes from aneurysmal subarachnoid hemorrhage (SAH) varies widely and has not been fully elucidated to date in Vietnam. Understanding the risk and prognosis of aneurysmal SAH is important to reduce poor outcomes in Vietnam. The aim of this study, therefore, was to investigate the rate of poor outcome at 90 days of ictus and associated factors from aneurysmal SAH in the country. METHODS We performed a multicenter prospective cohort study of patients (≥18 years) presenting with aneurysmal SAH to three central hospitals in Hanoi, Vietnam, from August 2019 to August 2020. We collected data on the characteristics, management, and outcomes of patients with aneurysmal SAH and compared these data between good (defined as modified Rankin Scale (mRS) of 0 to 3) and poor (mRS, 4-6) outcomes at 90 days of ictus. We assessed factors associated with poor outcomes using logistic regression analysis. RESULTS Of 168 patients with aneurysmal SAH, 77/168 (45.8%) were men, and the median age was 57 years (IQR: 48-67). Up to 57/168 (33.9%) of these patients had poor outcomes at 90 days of ictus. Most patients underwent sudden-onset and severe headache (87.5%; 147/168) and were transferred from local to participating central hospitals (80.4%, 135/168), over half (57.1%, 92/161) of whom arrived in central hospitals after 24 hours of ictus, and the initial median World Federation of Neurological Surgeons (WFNS) grading score was 2 (IQR: 1-4). Nearly half of the patients (47.0%; 79/168) were treated with endovascular coiling, 37.5% (63/168) were treated with surgical clipping, the remaining patients (15.5%; 26/168) did not receive aneurysm repair, and late rebleeding and delayed cerebral ischemia (DCI) occurred in 6.1% (10/164) and 10.4% (17/163) of patients, respectively. An initial WFNS grade of IV (odds ratio, OR: 15.285; 95% confidence interval, CI: 3.096-75.466) and a grade of V (OR: 162.965; 95% CI: 9.975-2662.318) were independently associated with poor outcomes. Additionally, both endovascular coiling (OR: 0.033; 95% CI: 0.005-0.235) and surgical clipping (OR: 0.046; 95% CI: 0.006-0.370) were inversely and independently associated with poor outcome. Late rebleeding (OR: 97.624; 95% CI: 5.653-1686.010) and DCI (OR: 15.209; 95% CI: 2.321-99.673) were also independently associated with poor outcome. CONCLUSIONS Improvements are needed in the management of aneurysmal SAH in Vietnam, such as increasing the number of aneurysm repairs, performing earlier aneurysm treatment by surgical clipping or endovascular coiling, and improving both aneurysm repairs and neurocritical care.
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Affiliation(s)
- Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
- * E-mail:
| | - Hung Manh Ngo
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
- Department of Neurosurgery II, Neurosurgery Center, Vietnam-Germany Friendship Hospital, Hanoi, Vietnam
| | - Hai Bui Hoang
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Dung Thi Pham
- Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tuan Anh Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Tran
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
- Radiology Centre, Bach Mai Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Duong Ngoc Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Son Ngoc Do
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - My Ha Nguyen
- Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hung Dinh Vu
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Hien Thi Thu Vuong
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Emergency Department, Vietnam–Czechoslovakia Friendship Hospital, Hai Phong, Vietnam
| | - Ton Duy Mai
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Stroke Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Anh Quang Nguyen
- Radiology Centre, Bach Mai Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Kien Hoang Le
- Radiology Centre, Bach Mai Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Phuong Viet Dao
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Stroke Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Thong Huu Tran
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Luu Dang Vu
- Radiology Centre, Bach Mai Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Linh Quoc Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | | | - He Van Dong
- Department of Neurosurgery I, Neurosurgery Center, Vietnam-Germany Friendship Hospital, Hanoi, Vietnam
| | - Hao The Nguyen
- Department of Neurosurgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Anh Dat Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
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Kremer B, Coburn M, Weinandy A, Nolte K, Clusmann H, Veldeman M, Höllig A. Argon treatment after experimental subarachnoid hemorrhage: evaluation of microglial activation and neuronal survival as a subanalysis of a randomized controlled animal trial. Med Gas Res 2021; 10:103-109. [PMID: 33004706 PMCID: PMC8086619 DOI: 10.4103/2045-9912.296039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hereinafter, we evaluate argon's neuroprotective and immunomodulatory properties after experimental subarachnoid hemorrhage (SAH) examining various localizations (hippocampal and cortical regions) with respect to neuronal damage and microglial activation 6, 24 and 72 hours after SAH. One hour after SAH (endovascular perforation rat model) or sham surgery, a mixture of gas containing 50% argon (argon group) or 50% nitrogen (control group) was applied for 1 hour. At 6 hours after SAH, argon reduced neuronal damage in the hippocampal regions in the argon group compared to the control group (P < 0.034). Hippocampal microglial activation did not differ between the treatment groups over time. The basal cortical regions did not show a different lesion pattern, but microglial activation was significantly reduced in the argon group 72 hours after SAH (P = 0.034 vs. control group). Whereas callosal microglial activation was significantly reduced at 24 hours in the argon-treated group (P = 0.018). Argon treatment ameliorated only early hippocampal neuronal damage after SAH. Inhibition of microglial activation was seen in some areas later on. Thus, argon may influence the microglial inflammatory response and neuronal survival after SAH; however, due to low sample sizes the interpretation of our results is limited. The study protocol was approved by the Government Agency for Animal Use and Protection (Protocol number: TVA 10416G1; initially approved by the "Landesamt für Natur, Umwelt und Verbraucherschutz NRW," Recklinghausen, Germany, on April 28, 2009).
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Affiliation(s)
- Benedikt Kremer
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Mark Coburn
- Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Agnieszka Weinandy
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Kay Nolte
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Veldeman
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Anke Höllig
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
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5
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Roquer J, Cuadrado-Godia E, Guimaraens L, Conesa G, Rodríguez-Campello A, Capellades J, García-Arnillas MP, Fernández-Candil JL, Avellaneda-Gómez C, Giralt-Steinhauer E, Jiménez-Conde J, Soriano-Tárraga C, Villalba-Martínez G, Vivanco-Hidalgo RM, Vivas E, Ois A. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage. Neurology 2020; 95:e1819-e1829. [PMID: 32796129 PMCID: PMC7682825 DOI: 10.1212/wnl.0000000000010618] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe short-term and 5-year rates of mortality and poor outcome in patients with spontaneous aneurysmal subarachnoid hemorrhage (aSAH) who received repair treatment. METHODS In this prospective observational study, mortality and poor outcome (modified Rankin Scale score 3-6) were analyzed in 311 patients with aSAH at 3 months, 1 year, and 5 years follow-up. Sensitivity analysis was performed according to treatment modality. In-hospital and 5-year complications were analyzed. RESULTS Of 476 consecutive patients with spontaneous subarachnoid hemorrhage, 347 patients (72.9%) had aSAH. Of these, 311 (89.6%) were treated (242 endovascular, 69 neurosurgical), with a mean follow-up of 43.4 months (range, 1 to 145). Three-month, 1-year, and 5-year mortality was 18.4%, 22.9%, and 29.0%, and poor outcome was observed in 42.3%, 36.0%, and 36.0%, respectively. Adjusted poor outcome was lower in endovascular than in neurosurgical treatment at 3 months (odds ratio [OR] 0.36 [95% confidence interval [CI] 0.18-0.74]), with an absolute difference of 15.8% (number needed to treat = 6.3), and at 1 year (OR = 0.40 [95% CI 0.20-0.81]), with an absolute difference of 15.9% (number needed to treat = 6.3). Complications did not differ between the 2 procedures. However, mechanical ventilation was less frequent with the endovascular technique (OR 0.67 [95% CI 0.54-0.84]). CONCLUSIONS Patients with aSAH treated according to current guidelines had a short-term mortality of 18.4% and 5-year mortality of 29%. The majority (64.0%) of patients remained alive without disabilities at 5-year follow-up. Patients prioritized to endovascular treatment had better outcomes than those referred to neurosurgery because endovascular coiling was not feasible.
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Affiliation(s)
- Jaume Roquer
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain.
| | - Elisa Cuadrado-Godia
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Leopoldo Guimaraens
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Gerardo Conesa
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Ana Rodríguez-Campello
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Jaume Capellades
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - María P García-Arnillas
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Juan L Fernández-Candil
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Carla Avellaneda-Gómez
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Eva Giralt-Steinhauer
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Jordi Jiménez-Conde
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Carolina Soriano-Tárraga
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Gloria Villalba-Martínez
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Rosa M Vivanco-Hidalgo
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Elio Vivas
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
| | - Angel Ois
- From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain
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6
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Gong L, Gu Y, Dong Q, Zhang X, Wang H, Zhao Y, Liu X. A Direct Correlation between Red Blood Cell Indices and Cognitive Impairment After Aneurysmal Subarachnoid Hemorrhage (aSAH). Curr Neurovasc Res 2020; 16:142-147. [PMID: 30977449 DOI: 10.2174/1567202616666190412142718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cognitive impairment can occur after aneurysmal subarachnoid hemorrhage (aSAH) though it commonly tends to be neglected. Red blood cell (RBC) indices are associated with long-term functional outcomes, while it is unclear whether RBC indices could be a potential predictor of cognitive decline after aSAH. We aimed to investigate the association between RBC indices and post-aSAH cognitive impairment at 1 year. METHODS Patients with aSAH received neuropsychological test by the Montreal Cognitive Assessment (MoCA) and underwent serum and cerebrospinal fluid (CSF) samples test. To determine the association between RBC indices and cognitive impairment after acute aSAH, we adjusted for demographic and vascular risk factors using multivariate logistic regression analysis. RESULTS Of the 126 patients included in this study, 33% (42/126) of them were diagnosed with cognitive impairment (MoCA<26). After adjustment for potential confounders, increased mean corpuscular volume (MCV) (OR: 1.36, 95%CI: 1.19-1.55) and mean corpuscular hemoglobin (MCH) (OR: 1.61, 95%CI: 1.25-2.08), reflecting systemic iron status, are more likely to be associated with cognitive impairment after aSAH. CONCLUSION In this aSAH population, our data shows the positive association between MCH and MCV and cognitive impairment at 1 year.
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Affiliation(s)
- Li Gong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Yongzhe Gu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Qiong Dong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Xiang Zhang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Haichao Wang
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
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7
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Rackauskaite D, Svanborg E, Andersson E, Löwhagen K, Csajbok L, Nellgård B. Prospective study: Long-term outcome at 12-15 years after aneurysmal subarachnoid hemorrhage. Acta Neurol Scand 2018; 138:400-407. [PMID: 29963687 DOI: 10.1111/ane.12980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
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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Affiliation(s)
- D. Rackauskaite
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
- Institution of clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Svanborg
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
| | - E. Andersson
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
- Institution of clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - K. Löwhagen
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
- Institution of clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Csajbok
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
| | - B. Nellgård
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
- Institution of clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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8
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Howard BM, Barrow DL. Outcomes for Patients with Poor-Grade Subarachnoid Hemorrhage: To Treat or Not To Treat? World Neurosurg 2015; 86:30-2. [PMID: 26498399 DOI: 10.1016/j.wneu.2015.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Brian M Howard
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Barrow
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
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9
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Huhtakangas J, Lehto H, Seppä K, Kivisaari R, Niemelä M, Hernesniemi J, Lehecka M. Long-Term Excess Mortality After Aneurysmal Subarachnoid Hemorrhage. Stroke 2015; 46:1813-8. [DOI: 10.1161/strokeaha.115.009288] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
There is high case-fatality rate and loss of productive life-years related to aneurysmal subarachnoid hemorrhage (aSAH) but data on long-term survival of patients with aSAH are scarce. We aim to evaluate long-term excess mortality and related risk factors after an aSAH event.
Methods—
Survivors (n=3078) of aSAH who had survived for ≥1 year were reviewed for this retrospective follow-up study, which was conducted in the Department of Neurosurgery in Helsinki between 1980 and 2007. Follow-up started 1 year after the aSAH and continued until death or the end of 2012 (48 918 patient-years). Mortality and relative survival ratios were derived using a matched general population.
Results—
Survivors of aSAH after 20 years showed 17% excess mortality compared with the general population. Even young patients and patients with good recovery showed excess mortality. The highest excess mortality was among patients with multiple aneurysms, old age, poor preoperative clinical condition, conservative aneurysm treatment, and unfavorable clinical outcome at 1 year.
Conclusions—
Even after initially favorable recovery from an aSAH, survivors experience excess mortality in the long run in comparison to a matched general population. Cardiovascular disease at younger age and cerebrovascular events were overrepresented as causes of death, which indicates the importance of treatment of vascular risk factors. Young patients and patients with multiple aneurysms who are recovering from an aSAH should be followed-up and treated most actively.
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Affiliation(s)
- Justiina Huhtakangas
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Hanna Lehto
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Karri Seppä
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Riku Kivisaari
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Mika Niemelä
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Juha Hernesniemi
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
| | - Martin Lehecka
- From the Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (J.H., H.L., R.K., M.N., J.H., M.L.); and Finnish Cancer Registry, Helsinki, Finland (K.S.)
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10
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Howard BM, Barrow DL. Screening for Unruptured Intracranial Aneurysms: Who and When? World Neurosurg 2014; 82:e163-5. [DOI: 10.1016/j.wneu.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
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Affiliation(s)
- Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
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12
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Nieuwkamp DJ, de Wilde A, Wermer MJH, Algra A, Rinkel GJE. Long-term outcome after aneurysmal subarachnoid hemorrhage—risks of vascular events, death from cancer and all-cause death. J Neurol 2014; 261:309-15. [DOI: 10.1007/s00415-013-7192-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
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Korja M, Silventoinen K, Laatikainen T, Jousilahti P, Salomaa V, Kaprio J. Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage. Neurology 2013; 80:481-6. [PMID: 23303843 DOI: 10.1212/wnl.0b013e31827f0fb5] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess long-term, cause-specific mortality rates and rate ratios of the patients alive at 1 year after subarachnoid hemorrhage (SAH). METHODS The population-based, prospective, cohort study with a nested case-control design consisted of 64,349 persons (aged 25-74 years at enrollment) who participated in the National FINRISK Study between 1972 and 2007. Four hundred thirty-seven SAH cases, 233 one-year SAH survivors, and their matched intrinsic controls were identified and followed up until the end of 2009 through the nationwide Finnish Causes of Death Register. All-cause mortality rates and rate ratios of the 1-year SAH survivors and controls were the main outcome measures. RESULTS Eighty-eight (37.8%) of 233 one-year SAH survivors died during the total follow-up time of 2,487 person-years (median 8.6 years, range 0.1-35.8 years). The 1-year SAH survivors had a hazard ratio of 1.96 (95% confidence interval 1.57-2.47) for death compared with the matched general population with 10 controls for each SAH survivor. One-year SAH survivors had up to 31 additional deaths per 1,000 person-years compared with controls with minimal cerebrovascular risk factors. The higher long-term risk of death among SAH survivors was attributed solely to cerebrovascular diseases, and most important modifiable risk factors for death were smoking, high systolic blood pressure (≥ 159 mm Hg), and high cholesterol levels (≥ 7.07 mmol/L). CONCLUSION One-year SAH survivors have excess mortality, which is attributed to an exceptional risk of deadly cerebrovascular events. Aggressive post-SAH cerebrovascular risk factor intervention strategies are highly warranted.
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Affiliation(s)
- Miikka Korja
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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14
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Affiliation(s)
- Albert J Schuette
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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15
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Nieuwkamp DJ, Vaartjes I, Algra A, Rinkel GJE, Bots ML. Risk of cardiovascular events and death in the life after aneurysmal subarachnoid haemorrhage: a nationwide study. Int J Stroke 2012; 9:1090-6. [PMID: 22973950 DOI: 10.1111/j.1747-4949.2012.00875.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM The increased mortality rates of survivors of aneurysmal subarachnoid haemorrhage have been attributed to an increased risk of cardiovascular events in a registry study in Sweden. Swedish registries have however not been validated for subarachnoid haemorrhage and Scandinavian incidences of cardiovascular disease differ from that in Western European countries. We assessed risks of vascular disease and death in subarachnoid haemorrhage survivors in the Netherlands. METHODS From the Dutch hospital discharge register, we identified all patients with subarachnoid haemorrhage admission between 1997 and 2008. We determined the accuracy of coding of the diagnosis subarachnoid haemorrhage for patients admitted to our centre. Conditional on survival of three-months after the subarachnoid haemorrhage, we calculated standardized incidence and mortality ratios for fatal or nonfatal vascular diseases, vascular death, and all-cause death. Cumulative risks were estimated with survival analysis. RESULTS The diagnosis of nontraumatic subarachnoid haemorrhage was correct in 95·4% of 1472 patients. Of 11,263 admitted subarachnoid haemorrhage patients, 6999 survived more than three-months. During follow-up (mean 5·1 years), 874 (12·5%) died. The risks of death were 3·3% within one-year, 11·3% within five-years, and 21·5% within 10 years. The standardized mortality ratio was 3·4 (95% confidence interval: 3·1 to 3·7) for vascular death and 2·2 (95% confidence interval: 2·1 to 2·3) for all-cause death. The standardized incidence ratio for fatal or nonfatal vascular diseases was 2·7 (95% confidence interval: 2·6 to 2·8). CONCLUSIONS Dutch hospital discharge and cause of death registries are a valid source of data for subarachnoid haemorrhage, and show that the increased mortality rate in subarachnoid haemorrhage survivors is explained by increased risks for vascular diseases and death.
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Affiliation(s)
- Dennis J Nieuwkamp
- Departments of Neurology and Neurosurgery, the Rudolf Magnus Institute of Neuroscience, Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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Koroknay-Pál P, Laakso A, Lehto H, Seppä K, Kivisaari R, Hernesniemi J, Niemelä M. Long-term excess mortality in pediatric patients with cerebral aneurysms. Stroke 2012; 43:2091-6. [PMID: 22693125 DOI: 10.1161/strokeaha.112.650077] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Knowledge of the long-term excess mortality in pediatric aneurysm patients is lacking. The aim of this study was to assess the long-term excess mortality of 102 pediatric patients with cerebral aneurysm treated at the department of neurosurgery at Helsinki University Central Hospital between 1937 and 2009. METHODS Patients were followed from diagnosis until death or the end of the year 2010. Relative survival ratio provided the measure of excess mortality in these patients compared with mortality of the general Finnish population matched by age, sex, and calendar time. RESULTS A majority of the patients (n=89) presented with subarachnoid hemorrhage. Aneurysms (n=118) were treated operatively (n=79), endovascularly (n=1), or conservatively (n=36). The mean follow-up time was 26.8 years (range, 0-55.6 years). By the end of follow-up, 34 of the 102 patients had died; 26 of these deaths (76%) were aneurysm-related. There was overall excess mortality of 10% (cumulative relative survival ratio, 0.90; 95% CI, 0.80-0.96) and 19% (cumulative relative survival ratio, 0.81; 95% CI, 0.66-0.91) at 20 and 40 years after the diagnosis among the 1-year subarachnoid hemorrhage survivors, respectively. The excess mortality was particularly high in boys. There was no long-term excess mortality among patients with unruptured aneurysms. Aneurysm-related deaths included rebleedings from open or partially occluded aneurysms, epileptic seizures, de novo and recurrent aneurysms, or sequelae of subarachnoid hemorrhage. CONCLUSIONS There is long-term excess mortality in pediatric patients with aneurysm even decades after successful treatment of a ruptured aneurysm, especially among boys. The excess mortality is mainly aneurysm-related.
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Affiliation(s)
- Päivi Koroknay-Pál
- Department of Neurosurgery, Helsinki University Central Hospital, Finland.
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Huttunen T, Riihinen A, Pukkala E, von und zu Fraunberg M, Koivisto T, Ronkainen A, Rinne J, Hernesniemi J, Sankila R, Jääskeläinen JE. Increased Relative Risk of Lung Cancer in 2,904 Patients with Saccular Intracranial Aneurysm Disease in Eastern Finland. Neuroepidemiology 2012; 38:93-9. [DOI: 10.1159/000335041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 11/14/2011] [Indexed: 12/31/2022] Open
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Nieuwkamp DJ, Algra A, Blomqvist P, Adami J, Buskens E, Koffijberg H, Rinkel GJ. Excess Mortality and Cardiovascular Events in Patients Surviving Subarachnoid Hemorrhage. Stroke 2011; 42:902-7. [DOI: 10.1161/strokeaha.110.602722] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dennis J. Nieuwkamp
- From the Department of Neurology (D.J.N., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and Julius Center for Health Sciences and Primary Care (A.A., H.K.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medicine at Karolinska University Hospital Solna, and Clinical Epidemiology Unit, Karolinska Institute (P.B., J.A.), Stockholm, Sweden; and Department of Epidemiology (E.B.), University Medical Center Groningen, Groningen, The Netherlands
| | - Ale Algra
- From the Department of Neurology (D.J.N., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and Julius Center for Health Sciences and Primary Care (A.A., H.K.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medicine at Karolinska University Hospital Solna, and Clinical Epidemiology Unit, Karolinska Institute (P.B., J.A.), Stockholm, Sweden; and Department of Epidemiology (E.B.), University Medical Center Groningen, Groningen, The Netherlands
| | - Paul Blomqvist
- From the Department of Neurology (D.J.N., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and Julius Center for Health Sciences and Primary Care (A.A., H.K.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medicine at Karolinska University Hospital Solna, and Clinical Epidemiology Unit, Karolinska Institute (P.B., J.A.), Stockholm, Sweden; and Department of Epidemiology (E.B.), University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna Adami
- From the Department of Neurology (D.J.N., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and Julius Center for Health Sciences and Primary Care (A.A., H.K.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medicine at Karolinska University Hospital Solna, and Clinical Epidemiology Unit, Karolinska Institute (P.B., J.A.), Stockholm, Sweden; and Department of Epidemiology (E.B.), University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Buskens
- From the Department of Neurology (D.J.N., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and Julius Center for Health Sciences and Primary Care (A.A., H.K.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medicine at Karolinska University Hospital Solna, and Clinical Epidemiology Unit, Karolinska Institute (P.B., J.A.), Stockholm, Sweden; and Department of Epidemiology (E.B.), University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrik Koffijberg
- From the Department of Neurology (D.J.N., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and Julius Center for Health Sciences and Primary Care (A.A., H.K.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medicine at Karolinska University Hospital Solna, and Clinical Epidemiology Unit, Karolinska Institute (P.B., J.A.), Stockholm, Sweden; and Department of Epidemiology (E.B.), University Medical Center Groningen, Groningen, The Netherlands
| | - Gabriël J.E. Rinkel
- From the Department of Neurology (D.J.N., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and Julius Center for Health Sciences and Primary Care (A.A., H.K.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medicine at Karolinska University Hospital Solna, and Clinical Epidemiology Unit, Karolinska Institute (P.B., J.A.), Stockholm, Sweden; and Department of Epidemiology (E.B.), University Medical Center Groningen, Groningen, The Netherlands
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Huttunen T, von und zu Fraunberg M, Koivisto T, Ronkainen A, Rinne J, Sankila R, Seppä K, Jääskeläinen JE. Long-term Excess Mortality of 244 Familial and 1502 Sporadic One-Year Survivors of Aneurysmal Subarachnoid Hemorrhage Compared With a Matched Eastern Finnish Catchment Population. Neurosurgery 2011; 68:20-7. [DOI: 10.1227/neu.0b013e3181ff33ca] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
BACKGROUND:
Saccular intracranial aneurysms (sIAs) develop in 2% of the population. Rupture of the sIA wall causes almost all cases of aneurysmal subarachnoid hemorrhage (aSAH).
OBJECTIVE:
We analyzed the long-term excess mortality of 244 familial and 1502 sporadic 1-year survivors of aSAH from sIA compared with a matched Eastern Finnish catchment population.
METHODS:
The Kuopio Neurosurgery Database contains 1746 one-year survivors of aSAH (1980–2007) from a defined population. The median follow-up time, until death (n = 494) or the end of 2008, was 12 years. Relative survival ratios were calculated compared with the matched (sex, age, calendar time) catchment population. Relative excess risk of death (RER) was estimated for variables known on admission for aSAH as well as Glasgow Outcome Scale score at 12 months.
RESULTS:
There was 12% excess mortality at 15 years (cumulative relative survival ratio: 0.88; 95% confidence interval: 0.85-0.91). Independent risk factors were male sex (RER: 1.6), age older than 64 years (RER: 2.9), ruptured basilar tip sIA (RER: 4.5), severe hydrocephalus on admission (RER: 3.6), no occlusive therapy (RER: 6.0), and Glasgow Outcome Scale scores of 2, 3, or 4 at 12 months (RER: 23, 4.1, 2.1, respectively), but not familial sIA disease. There were lethal rebleeds from 13 of the 1440 clipped sIAs, 2 of the 265 coiled sIAs, and 2 from the 17 nonoccluded sIAs, and 14 new lethal bleeds from other sIAs.
CONCLUSION:
The impact of both sporadic and familial aSAH and their sequelae in the central nervous and cardiovascular systems may cause long-term morbidity and mortality. The complex sIA disease may predispose to other vascular events later in life. The causes of the long-term excess mortality are heterogeneous, and more detailed analyses are required.
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Affiliation(s)
- Terhi. Huttunen
- Neurosurgery of Kuopio University Hospital, NeuroCenter, Kuopio, Finland
| | | | - Timo. Koivisto
- Neurosurgery of Kuopio University Hospital, NeuroCenter, Kuopio, Finland
| | - Antti. Ronkainen
- Neurosurgery of Kuopio University Hospital, NeuroCenter, Kuopio, Finland
| | - Jaakko. Rinne
- Neurosurgery of Kuopio University Hospital, NeuroCenter, Kuopio, Finland
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Schaafsma JD, Koffijberg H, Buskens E, Velthuis BK, van der Graaf Y, Rinkel GJE. Cost-effectiveness of magnetic resonance angiography versus intra-arterial digital subtraction angiography to follow-up patients with coiled intracranial aneurysms. Stroke 2010; 41:1736-42. [PMID: 20595661 DOI: 10.1161/strokeaha.110.585083] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and the impact of discrepancies on health benefits and costs is unknown. We evaluated the cost-effectiveness of follow-up with MRA vs IA-DSA to assess whether in this setting MRA may replace IA-DSA. METHODS We studied aneurysm occlusion on MRA in addition to follow-up IA-DSA in 310 patients with 341 coiled intracranial aneurysms. The observed sensitivity (82%) and specificity (89%) of MRA for detection of reopening with IA-DSA as a reference were used as input for a Markov decision-analytic model. Other determinants were derived from the literature. We compared life expectancy, quality-adjusted life-years (QALY), costs, and expected number of events for the two strategies. RESULTS Follow-up with MRA yielded similar life expectancy (MRA, 26.66 years; IA-DSA, 26.63 years; difference, 0.03 years; 95% CI, -0.17-0.23) and QALY (MRA, 10.96; IA-DSA, 10.95; difference, 0.01 QALY; 95% CI, -0.05-0.08) at lower costs (MRA, $7003; IA-DSA, $8241 per patient; difference, -$1238; 95% CI, -2617--36). The expected number of events was comparable except for complications from IA-DSA. CONCLUSIONS MRA provided equivalent health benefits as IA-DSA and was cost-saving. MRA dominates and should replace routine IA-DSA to follow-up patients with coiled aneurysms.
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Affiliation(s)
- Joanna D Schaafsma
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, the Netherlands.
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