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

Background: Recent literature has shown increasing numbers of spontaneous nonaneurysmal subarachnoid hemorrhage patients over the past few years. It was considered to have better prognosis than the aneurysmal subarachnoid hemorrhage but small series suggested that some patients behave differently. There is a 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 cities. A total of 209 consecutive patients admitted with spontaneous nonaneurysmal subarachnoid hemorrhage over a period of 12 years (2007–2019). 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's grade and the World Federation of Neurosurgeons Scale score, perimesencephalic and nonperimesencephalic subarachnoid hemorrhage on initial brain CT scan), as well as functional outcome (measured using modified Rankin's scale). Multivariable logistic regression was used to identify predictors of functional outcome.

Results: Over the past 12 years, 209 patients met our inclusion criteria. In our study, 44.49% of our patients had perimesencephalic subarachnoid hemorrhage and 55.51% had nonperimesencephalic subarachnoid hemorrhage. The baseline morbidity and characteristics wear similar in both groups. Hydrocephalus was the most common complication followed by vasospasm with 22.48 and 18.66%, respectively. The complication and death wear more frequent in nonperimesencephalic subarachnoid hemorrhage with high Hunt and Hess grades. Among poor grade nonperimesencephalic subarachnoid hemorrhage multivariable analysis identified age above 65 years (p < 0.001), hyperglycemia (p < 0.04), and vasospasm (p < 0.001) as significant predictive factors of poor functional outcome.

Conclusion: The functional outcome was strongly predicted by unmodifiable factor like patient age 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 nonaneurysmal subarachnoid hemorrhage. These patients should be managed in respect to their differences, to improve clinical outcome and optimize health care resources.

Publication History

Article published online:
12 February 2021