Introduction: Individuals with a poor-grade aneurysmal subarachnoid hemorrhage (PG[ASAH]) are known for an exceptional grim prognosis despite maximal treatment.
Aim: To identify individuals with PGASAH who can benefit from further treatment, we analyzed the risk factors related to poor outcome.
Methods: Patients with PGASAH defined as World Federation of Neurosurgical Society (WFNS) grades IV or V who underwent aneurysm treatment between 01/2003-06/2016, were included in this retrospective study (n=348). The primary endpoint was unfavorable outcome at the 6-month follow-up defined as the modified Rankin scale >2. We analyzed over 100 potential risk factors assessable at admission and during the hospital stay. We developed a nomogram for the prediction of poor outcome after PGASAH.
Result: The median age of PGASAH patients was 55.1 years, 64.9% were females. Of 19 potential risk factors identified in the univariate analysis, age>55 years (p=0.002, adjusted odds ratio [aOR]=2.44), premorbid cardiac valve disease (p=0.004, aOR=6.50), dilated pupil(s) at admission (p=0.025, aOR=2.64), early (≤72h post-aSAH, p<0.001, aOR=5.56) and delayed (>72h, p<0.001, aOR=5.09) cerebral infarction in the follow-up computed tomography scan(s) were confirmed as independent risk factors for poor outcomes after PGASAH in the final multivariate analysis. A nomogram integrating these factors formed a concise and effective predictive model. A decision curve analysis affirmed practical applicability in clinical settings.
Conclusion: The proposed nomogram for outcome prognostication after PGASAH is easily and might become a valuable tool for clinicians for early treatment decisions and contribute to optimizing treatment strategies. An external validation of the nomogram is necessary.
Funding: None.