High-Grade Aneurysmal Subarachnoid Hemorrhage

Predictors of Functional Outcome

Natasha Ironside, Thomas J. Buell, Ching Jen Chen, Jeyan S. Kumar, Gabriella M. Paisan, Jennifer D. Sokolowski, Kenneth Liu, Dale Ding

Research output: Contribution to journalArticle

Abstract

Background: Because the prognosis of high-grade aneurysmal subarachnoid hemorrhage (aSAH), classified as World Federation of Neurosurgical Societies (WFNS) grade IV–V, is generally poor, the functional outcomes of survivors have not been thoroughly explored. The aim of this retrospective cohort study is to determine predictors of functional independence in patients who survive a high-grade aSAH. Methods: We retrospectively evaluated consecutive patients with aSAH admitted to a single institution from January 2000 to April 2015. Adult (age ≥18 years) patients with WFNS grade IV–V aSAH were included for analysis. Patients without sufficient baseline data, those who died before discharge, and those without follow-up data were excluded. Univariable and multivariable logistic regression analyses were used to identify factors associated with functional independence, defined as a modified Rankin Scale score of 0–2, at last follow-up. Results: Of the 260 patients with a WFNS grade IV–V aSAH during the study period, 139 met the inclusion criteria. After a mean follow-up of 6.3 months, functional independence was achieved in 73% of high-grade aSAH survivors (101/139 patients) and in 39% of all high-grade aSAH cases (101/260 patients). Only a lack of cerebrospinal fluid shunt placement was found to be an independent predictor of functional independence in the multivariable analysis (odds ratio 0.28 [0.109–0.722]; P = 0.008). Conclusions: Because functional independence can be achieved in the majority of high-grade aSAH survivors, aggressive initial management of high-grade aSAH is warranted. Strategies that reduce the need for permanent cerebrospinal fluid diversion may improve functional outcomes in survivors of high-grade aSAH.

Original languageEnglish (US)
Pages (from-to)e723-e728
JournalWorld neurosurgery
Volume125
DOIs
StatePublished - May 1 2019

Fingerprint

Subarachnoid Hemorrhage
Survivors
Cerebrospinal Fluid Shunts
Cerebrospinal Fluid
Cohort Studies
Retrospective Studies
Logistic Models
Odds Ratio
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Ironside, N., Buell, T. J., Chen, C. J., Kumar, J. S., Paisan, G. M., Sokolowski, J. D., ... Ding, D. (2019). High-Grade Aneurysmal Subarachnoid Hemorrhage: Predictors of Functional Outcome. World neurosurgery, 125, e723-e728. https://doi.org/10.1016/j.wneu.2019.01.162
Ironside, Natasha ; Buell, Thomas J. ; Chen, Ching Jen ; Kumar, Jeyan S. ; Paisan, Gabriella M. ; Sokolowski, Jennifer D. ; Liu, Kenneth ; Ding, Dale. / High-Grade Aneurysmal Subarachnoid Hemorrhage : Predictors of Functional Outcome. In: World neurosurgery. 2019 ; Vol. 125. pp. e723-e728.
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abstract = "Background: Because the prognosis of high-grade aneurysmal subarachnoid hemorrhage (aSAH), classified as World Federation of Neurosurgical Societies (WFNS) grade IV–V, is generally poor, the functional outcomes of survivors have not been thoroughly explored. The aim of this retrospective cohort study is to determine predictors of functional independence in patients who survive a high-grade aSAH. Methods: We retrospectively evaluated consecutive patients with aSAH admitted to a single institution from January 2000 to April 2015. Adult (age ≥18 years) patients with WFNS grade IV–V aSAH were included for analysis. Patients without sufficient baseline data, those who died before discharge, and those without follow-up data were excluded. Univariable and multivariable logistic regression analyses were used to identify factors associated with functional independence, defined as a modified Rankin Scale score of 0–2, at last follow-up. Results: Of the 260 patients with a WFNS grade IV–V aSAH during the study period, 139 met the inclusion criteria. After a mean follow-up of 6.3 months, functional independence was achieved in 73{\%} of high-grade aSAH survivors (101/139 patients) and in 39{\%} of all high-grade aSAH cases (101/260 patients). Only a lack of cerebrospinal fluid shunt placement was found to be an independent predictor of functional independence in the multivariable analysis (odds ratio 0.28 [0.109–0.722]; P = 0.008). Conclusions: Because functional independence can be achieved in the majority of high-grade aSAH survivors, aggressive initial management of high-grade aSAH is warranted. Strategies that reduce the need for permanent cerebrospinal fluid diversion may improve functional outcomes in survivors of high-grade aSAH.",
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Ironside, N, Buell, TJ, Chen, CJ, Kumar, JS, Paisan, GM, Sokolowski, JD, Liu, K & Ding, D 2019, 'High-Grade Aneurysmal Subarachnoid Hemorrhage: Predictors of Functional Outcome', World neurosurgery, vol. 125, pp. e723-e728. https://doi.org/10.1016/j.wneu.2019.01.162

High-Grade Aneurysmal Subarachnoid Hemorrhage : Predictors of Functional Outcome. / Ironside, Natasha; Buell, Thomas J.; Chen, Ching Jen; Kumar, Jeyan S.; Paisan, Gabriella M.; Sokolowski, Jennifer D.; Liu, Kenneth; Ding, Dale.

In: World neurosurgery, Vol. 125, 01.05.2019, p. e723-e728.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High-Grade Aneurysmal Subarachnoid Hemorrhage

T2 - Predictors of Functional Outcome

AU - Ironside, Natasha

AU - Buell, Thomas J.

AU - Chen, Ching Jen

AU - Kumar, Jeyan S.

AU - Paisan, Gabriella M.

AU - Sokolowski, Jennifer D.

AU - Liu, Kenneth

AU - Ding, Dale

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Because the prognosis of high-grade aneurysmal subarachnoid hemorrhage (aSAH), classified as World Federation of Neurosurgical Societies (WFNS) grade IV–V, is generally poor, the functional outcomes of survivors have not been thoroughly explored. The aim of this retrospective cohort study is to determine predictors of functional independence in patients who survive a high-grade aSAH. Methods: We retrospectively evaluated consecutive patients with aSAH admitted to a single institution from January 2000 to April 2015. Adult (age ≥18 years) patients with WFNS grade IV–V aSAH were included for analysis. Patients without sufficient baseline data, those who died before discharge, and those without follow-up data were excluded. Univariable and multivariable logistic regression analyses were used to identify factors associated with functional independence, defined as a modified Rankin Scale score of 0–2, at last follow-up. Results: Of the 260 patients with a WFNS grade IV–V aSAH during the study period, 139 met the inclusion criteria. After a mean follow-up of 6.3 months, functional independence was achieved in 73% of high-grade aSAH survivors (101/139 patients) and in 39% of all high-grade aSAH cases (101/260 patients). Only a lack of cerebrospinal fluid shunt placement was found to be an independent predictor of functional independence in the multivariable analysis (odds ratio 0.28 [0.109–0.722]; P = 0.008). Conclusions: Because functional independence can be achieved in the majority of high-grade aSAH survivors, aggressive initial management of high-grade aSAH is warranted. Strategies that reduce the need for permanent cerebrospinal fluid diversion may improve functional outcomes in survivors of high-grade aSAH.

AB - Background: Because the prognosis of high-grade aneurysmal subarachnoid hemorrhage (aSAH), classified as World Federation of Neurosurgical Societies (WFNS) grade IV–V, is generally poor, the functional outcomes of survivors have not been thoroughly explored. The aim of this retrospective cohort study is to determine predictors of functional independence in patients who survive a high-grade aSAH. Methods: We retrospectively evaluated consecutive patients with aSAH admitted to a single institution from January 2000 to April 2015. Adult (age ≥18 years) patients with WFNS grade IV–V aSAH were included for analysis. Patients without sufficient baseline data, those who died before discharge, and those without follow-up data were excluded. Univariable and multivariable logistic regression analyses were used to identify factors associated with functional independence, defined as a modified Rankin Scale score of 0–2, at last follow-up. Results: Of the 260 patients with a WFNS grade IV–V aSAH during the study period, 139 met the inclusion criteria. After a mean follow-up of 6.3 months, functional independence was achieved in 73% of high-grade aSAH survivors (101/139 patients) and in 39% of all high-grade aSAH cases (101/260 patients). Only a lack of cerebrospinal fluid shunt placement was found to be an independent predictor of functional independence in the multivariable analysis (odds ratio 0.28 [0.109–0.722]; P = 0.008). Conclusions: Because functional independence can be achieved in the majority of high-grade aSAH survivors, aggressive initial management of high-grade aSAH is warranted. Strategies that reduce the need for permanent cerebrospinal fluid diversion may improve functional outcomes in survivors of high-grade aSAH.

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Ironside N, Buell TJ, Chen CJ, Kumar JS, Paisan GM, Sokolowski JD et al. High-Grade Aneurysmal Subarachnoid Hemorrhage: Predictors of Functional Outcome. World neurosurgery. 2019 May 1;125:e723-e728. https://doi.org/10.1016/j.wneu.2019.01.162