Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage])

Martin Nikolaus Stienen; Menno Germans; Jan-Karl Burkhardt; Marian C Neidert; Christian Fung; David Bervini; Daniel Zumofen; Michel Röthlisberger; Serge Marbacher; Rodolfo Maduri; Thomas Robert; Martin A Seule; Philippe Bijlenga; Karl Schaller; Javier Fandino; Nicolas R Smoll; Nicolai Maldaner; Sina Finkenstädt; Giuseppe Esposito; Bawarjan Schatlo; Emanuela Keller; Oliver Bozinov; Luca Regli; Swiss SOS Study Group

doi:10.1161/STROKEAHA.117.019328

Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage])

Stroke. 2018 Feb;49(2):333-340. doi: 10.1161/STROKEAHA.117.019328. Epub 2018 Jan 15.

Authors

Martin Nikolaus Stienen¹, Menno Germans², Jan-Karl Burkhardt², Marian C Neidert², Christian Fung², David Bervini², Daniel Zumofen², Michel Röthlisberger², Serge Marbacher², Rodolfo Maduri², Thomas Robert², Martin A Seule², Philippe Bijlenga², Karl Schaller², Javier Fandino², Nicolas R Smoll², Nicolai Maldaner², Sina Finkenstädt², Giuseppe Esposito², Bawarjan Schatlo², Emanuela Keller², Oliver Bozinov², Luca Regli²; Swiss SOS Study Group

Affiliations

¹ From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., M.G., J.-K.B., M.C.N., N.M., S.F., G.E., E.K., O.B., L.R.); Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., D.B.); Department of Neurosurgery, University Hospital Basel, Switzerland (D.Z., M.R.); Department of Neurosurgery, Kantonsspital Aarau, Switzerland (S.M., J.F.); Department of Neurosurgery, University Hospital Lausanne, Switzerland (R.M.); Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland (T.R.); Department of Neurosurgery, Kantonsspital St.Gallen, Switzerland (M.A.S.); Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (P.B., K.S., N.R.S.); and Department of Neurosurgery, University Hospital Göttingen, Germany (B.S.). mnstienen@gmail.com.
² From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., M.G., J.-K.B., M.C.N., N.M., S.F., G.E., E.K., O.B., L.R.); Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., D.B.); Department of Neurosurgery, University Hospital Basel, Switzerland (D.Z., M.R.); Department of Neurosurgery, Kantonsspital Aarau, Switzerland (S.M., J.F.); Department of Neurosurgery, University Hospital Lausanne, Switzerland (R.M.); Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland (T.R.); Department of Neurosurgery, Kantonsspital St.Gallen, Switzerland (M.A.S.); Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (P.B., K.S., N.R.S.); and Department of Neurosurgery, University Hospital Göttingen, Germany (B.S.).

PMID: 29335333
DOI: 10.1161/STROKEAHA.117.019328

Abstract

Background and purpose: To identify predictors of in-hospital mortality in patients with aneurysmal subarachnoid hemorrhage and to estimate their impact.

Methods: Retrospective analysis of prospective data from a nationwide multicenter registry on all aneurysmal subarachnoid hemorrhage cases admitted to a tertiary neurosurgical department in Switzerland (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]; 2009-2015). Both clinical and radiological independent predictors of in-hospital mortality were identified, and their effect size was determined by calculating adjusted odds ratios (aORs) using multivariate logistic regression. Survival was displayed using Kaplan-Meier curves.

Results: Data of n=1866 aneurysmal subarachnoid hemorrhage patients in the Swiss SOS database were available. In-hospital mortality was 20% (n=373). In n=197 patients (10.6%), active treatment was discontinued after hospital admission (no aneurysm occlusion attempted), and this cohort was excluded from analysis of the main statistical model. In the remaining n=1669 patients, the rate of in-hospital mortality was 13.9% (n=232). Strong independent predictors of in-hospital mortality were rebleeding (aOR, 7.69; 95% confidence interval, 3.00-19.71; P<0.001), cerebral infarction attributable to delayed cerebral ischemia (aOR, 3.66; 95% confidence interval, 1.94-6.89; P<0.001), intraventricular hemorrhage (aOR, 2.65; 95% confidence interval, 1.38-5.09; P=0.003), and new infarction post-treatment (aOR, 2.57; 95% confidence interval, 1.43-4.62; P=0.002).

Conclusions: Several-and among them modifiable-factors seem to be associated with in-hospital mortality after aneurysmal subarachnoid hemorrhage. Our data suggest that strategies aiming to reduce the risk of rebleeding are most promising in patients where active treatment is initially pursued.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03245866.

Keywords: cerebral infarction; infarction; intracranial aneurysm; mortality; survival.

MeSH terms

Adult
Aged
Cerebral Infarction / complications
Cerebral Infarction / mortality
Databases, Factual
Female
Hospital Mortality*
Humans
Intracranial Aneurysm / mortality
Intracranial Aneurysm / therapy
Male
Middle Aged
Registries
Retrospective Studies
Subarachnoid Hemorrhage / complications
Subarachnoid Hemorrhage / mortality*

Associated data

ClinicalTrials.gov/NCT03245866