Turkish Neurosurgery 2024 , Vol 34 , Num 4
Predictors of Outcome in Aneurysmal Subarachnoid Hemorrhage: A Tertiary Center Experience
Merve ERGENC1,Ayten SARACOGLU2,Yasar BAYRI4,Ismail CINEL5,Beliz BILGILI6
1Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Türkiye
2Qatar University School of Medicine, Department of Clinical Anaesthesiology, Doha, Qatar
3ICU & Perioperative Medicine, Aisha Bint Hamad Al Attiyah Hospital, Department of Anesthesiology, Tinbak, Qatar
4Marmara University School of Medicine, Department of Neurosurgery, Istanbul, Türkiye
5Acibadem Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Türkiye
6Marmara University School of Medicine, Department of Anaesthesiology and Reanimation, Division of Intensive Care, Istanbul, Türkiye
DOI : 10.5137/1019-5149.JTN.43486-23.5 AIM: To determine the risk factors affecting the mortality rate and outcomes of patients with subarachnoid hemorrhage (SAH).

MATERIAL and METHODS: The records of patients who underwent aneurysm treatment and intensive care unit (ICU) followup in our hospital between 2013-2021 were reviewed retrospectively. Demographics of the patients, aneurysm characteristics, complications in the ICU, the Hunt Hess score, Glasgow Coma Scale (GCS), Acute Physiologic Assessment and Chronic Health Evaluation II score (APACHE II), sepsis status, and mechanical ventilation (MV) needed during ICU admission were collected. The generalized linear mixed modeling method was used to determine independent risk factors affecting mortality.

RESULTS: The records of 91 patients who met the inclusion criteria were analyzed. The age of the patients ranged from 21 to 86 years, and the female-to-male ratio was 6 / 7, with a mean age of 49.9 ± 13.06 years. The aneurysm treatment modality was surgical in 79 patients (86.8%) and endovascular in 12 patients (13.2%). The length of the ICU stay was mean 10.96 ± 13.66 days. While 64.8% (n=59) of the patients were discharged, 7.7% (n=7) were referred to palliative care units, and 25% (n=25) died. A one-unit increase in the APACHE II score was determined to increase the risk of vasospasm 1.154 times (p<0.001). Analysis showed that a one-day increase in the MV day increased the mortality risk 1.838 times (p<0.001), and vasospasm increased the mortality risk 32.151 times (p=0.004)

CONCLUSION: The length of hospital stay, the day of MV, and the presence of vasospasm were determined as independent risk factors affecting mortality. Early diagnosis and rapid treatment of vasospasm, which increases mortality during ICU follow-up, positively impact patient outcomes. Keywords : Intracranial aneurysm, Subarachnoid hemorrhage, Intracranial vasospasm, Mortality, APACHE, Intensive care

Corresponding author : Merve ERGENC, hekimoglumerve@gmail.com