Predictors of Functional Outcome in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Background: Aneurysmal subarachnoid hemorrhage carries a high mortality and morbidity. The last few years the mortality rate improved due to improving in the diagnostic and treatment modalities. However, the patients with poor-grade aneurysmal subarachnoid hemorrhage receive a less aggressive management, and there is little known about the factors predicting the functional outcome for these patients.

Study Design and Methods: This is a retrospective study conducted in large medical city. A total of 822 consecutive patients admitted with aneurysmal subarachnoid hemorrhage during a period of 10 years (2007–2017). We retrospectively reviewed the patient’s demographic features (age, sex, and BMI), severity of SAH at admission (Hunt and Hess grade, Glasgow Coma Scale score, Fisher grade, and the World Federation of Neurosurgeons Scale score), as well as functional outcome. Multivariable logistic regression was used to identify predictors of functional outcome.

Results: Total 181 out of 822 patient were classified as poor-grade aneurysmal subarachnoid hemorrhage based on Hunt and Hess Grades IV and V. Multivariable analysis identified aneurysmal size above 15 mm (p < 0.001), size of bleeding upon presentation (p < 0.001), age above 65 years (p < 0.001) as significant predictive factor of poor functional outcome. Also, we found hyperglycemia (p < 0.04) and leukocytosis (p < 0.002) predictor of poor functional outcome. On multivariate analysis, there was no significant association observed between presence of intraventricular bleeding (p = 0.09) seizure (p = 0.10) and long-term functional outcome.

Conclusion: We are reporting the largest study on functional outcome predictors in patients with poor-grade aneurysmal subarachnoid hemorrhage. The functional outcome was strongly predicted by unmodifiable factor like patient age on presentation and aneurysm size and modifiable factor like hyperglycemia. The new predictive scale based on our parameter appears to strongly predict the functional outcome in patients with poor-grade aneurysmal subarachnoid hemorrhage, which make it a strong tool in preoperative planning and management of these patients.