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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2022; 09(03): 142-148
DOI: 10.1055/s-0042-1756431
Original Article

Effect of Comorbidities on the Outcome of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Study

Sunaakshi Puri
1   Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Shalvi Mahajan
1   Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Kiran Jangra
1   Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Rajeev Chauhan
1   Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Sanjay Kumar
1   Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Ashish Aggarwal
2   Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Sameer Vyas
3   Department of Intervention Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Hemant Bhagat
1   Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Background The pathophysiological changes following aneurysmal subarachnoid hemorrhage (aSAH) lead to a varied degree of neurological deficit and cognitive decline. The presence of comorbidities can contribute to the progression and course of the disease resulting in high morbidity and mortality.

Methods A total of 140 patients with aSAH, scheduled for surgical clipping or endovascular coiling were included. The patients' comorbidities were recorded. The postoperative outcome was evaluated using Glasgow Outcome Scale at 1 month following discharge. Multiple logistic regression analysis was performed to identify variables predicting poor outcome, taking into consideration those variables which were significant in univariate analysis.

Results Sixty-six percent of these patients with aSAH had associated comorbidities. In our patient cohort, we found that smoking and hypertension were associated with worse outcome (odds ratio [OR] = 4.63 [confidence interval [CI] = 1.83–11.7] and OR = 2.92 [CI = 1.41–6.01], respectively). Hypothyroidism, diabetes mellitus, coronary artery disease, and asthma did not influence the neurological outcome because of their small number.

Conclusion Presence of comorbidities like smoking and hypertension significantly worsen the outcome of these patients with aSAH.

Keywords

aneurysmal subarachnoid hemorrhage - comorbidities - hypertension - smoking - Glasgow Outcome Scale


Publikationsverlauf

Artikel online veröffentlicht:
09. Dezember 2022

© 2022. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Etminan N, Chang HS, Hackenberg K. et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol 2019; 76 (05) 588-597
    CrossrefPubMedSuche in Google Scholar
  • 2 Kapoor K, Kak VK. Incidence of intracranial aneurysms in north-west Indian population. Neurol India 2003; 51 (01) 22-26
    PubMedSuche in Google Scholar
  • 3 Avdagic SS, Brkic H, Avdagic H, Smajic J, Hodzic S. Impact of comorbidity on early outcome of patients with subarachnoid hemorrhage caused by cerebral aneurysm rupture. Med Arh 2015; 69 (05) 280-283
    PubMedSuche in Google Scholar
  • 4 Dasenbrock HH, Rudy RF, Rosalind Lai PM. et al. Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: a nationwide analysis. J Neurosurg 2018; 129 (02) 446-457
    CrossrefPubMedSuche in Google Scholar
  • 5 Lindgren AE, Kurki MI, Riihinen A. et al. Type 2 diabetes and risk of rupture of saccular intracranial aneurysm in eastern Finland. Diabetes Care 2013; 36 (07) 2020-2026
    CrossrefPubMedSuche in Google Scholar
  • 6 Bhardwaj A, Bhagat H, Grover VK. et al. Comparison of propofol and desflurane for postanaesthetic morbidity in patients undergoing surgery for aneurysmal SAH: a randomized clinical trial. J Anesth 2018; 32 (02) 250-258
    CrossrefPubMedSuche in Google Scholar
  • 7 Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1 (7905): 480-484
    CrossrefPubMedSuche in Google Scholar
  • 8 Sodhi HB, Savardekar AR, Mohindra S, Chhabra R, Gupta V, Gupta SK. The clinical profile, management, and overall outcome of aneurysmal subarachnoid hemorrhage at the neurosurgical unit of a tertiary care center in India. J Neurosci Rural Pract 2014; 5 (02) 118-126
    Thieme ConnectPubMedSuche in Google Scholar
  • 9 Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med 2006; 354 (04) 387-396
    Suche in Google Scholar
  • 10 Jaja BNR, Lingsma H, Schweizer TA, Thorpe KE, Steyerberg EW, Macdonald RL. SAHIT collaboration. Prognostic value of premorbid hypertension and neurological status in aneurysmal subarachnoid hemorrhage: pooled analyses of individual patient data in the SAHIT repository. J Neurosurg 2015; 122 (03) 644-652
    CrossrefPubMedSuche in Google Scholar
  • 11 Juvela S. Prehemorrhage risk factors for fatal intracranial aneurysm rupture. Stroke 2003; 34 (08) 1852-1857
    CrossrefPubMedSuche in Google Scholar
  • 12 Juvela S, Siironen J, Kuhmonen J. Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage. J Neurosurg 2005; 102 (06) 998-1003
    CrossrefPubMedSuche in Google Scholar
  • 13 Kim J, Kim JH, Lee HS, Suh SH, Lee KY. Association between longitudinal blood pressure and prognosis after treatment of cerebral aneurysm: a nationwide population-based cohort study. PLoS One 2021; 16 (05) e0252042
    CrossrefPubMedSuche in Google Scholar
  • 14 Hammer A, Steiner A, Ranaie G. et al. Impact of comorbidities and smoking on the outcome in aneurysmal subarachnoid hemorrhage. Sci Rep 2018; 8 (01) 12335
    CrossrefPubMedSuche in Google Scholar
  • 15 Modesti PA, Reboldi G, Cappuccio FP. et al; ESH Working Group on CV Risk in Low Resource Settings. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One 2016; 11 (01) e0147601
    CrossrefPubMedSuche in Google Scholar
  • 16 Grundy SM, Stone NJ, Bailey AL. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73 (24) 3168-3209
    CrossrefPubMedSuche in Google Scholar
  • 17 Rinkel GJ, Prins NE, Algra A. Outcome of aneurysmal subarachnoid hemorrhage in patients on anticoagulant treatment. Stroke 1997; 28 (01) 6-9
    CrossrefPubMedSuche in Google Scholar
  • 18 Lindbohm JV, Kaprio J, Jousilahti P, Salomaa V, Korja M. Risk factors of sudden death from subarachnoid hemorrhage. Stroke 2017; 48 (09) 2399-2404
    CrossrefPubMedSuche in Google Scholar
  • 19 Gaetani P, Tartara F, Tancioni F, Klersy C, Forlino A, Baena RR. Activity of α 1-antitrypsin and cigarette smoking in subarachnoid haemorrhage from ruptured aneurysm. J Neurol Sci 1996; 141 (1-2): 33-38
    CrossrefPubMedSuche in Google Scholar
  • 20 Carandang RA, Barton B, Rordorf GA, Ogilvy CS, Sims JR. Nicotine replacement therapy after subarachnoid hemorrhage is not associated with increased vasospasm. Stroke 2011; 42 (11) 3080-3086
    CrossrefPubMedSuche in Google Scholar
  • 21 Krishna V, Kim DH. Ethnic differences in risk factors for subarachnoid hemorrhage. J Neurosurg 2007; 107 (03) 522-529
    CrossrefPubMedSuche in Google Scholar
  • 22 Feigin VL, Rinkel GJ, Lawes CM. et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005; 36 (12) 2773-2780
    CrossrefPubMedSuche in Google Scholar
  • 23 International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms–risk of rupture and risks of surgical intervention. N Engl J Med 1998; 339 (24) 1725-1733
    CrossrefPubMedSuche in Google Scholar
  • 24 Ragni MV, Lewis JH, Spero JA, Hasiba U. Bleeding and coagulation abnormalities in alcoholic cirrhotic liver disease. Alcohol Clin Exp Res 1982; 6 (02) 267-274
    CrossrefPubMedSuche in Google Scholar
  • 25 Juvela S. Alcohol consumption as a risk factor for poor outcome after aneurysmal subarachnoid haemorrhage. BMJ 1992; 304 (6843): 1663-1667
    CrossrefPubMedSuche in Google Scholar
  • 26 Kruyt ND, Biessels GJ, de Haan RJ. et al. Hyperglycemia and clinical outcome in aneurysmal subarachnoid hemorrhage: a meta-analysis. Stroke 2009; 40 (06) e424-e430
    CrossrefPubMedSuche in Google Scholar
  • 27 Suarez JI. Does hyperglycemia contribute to secondary injury in subarachnoid hemorrhage?. Stroke 2006; 37 (01) 8-9
    CrossrefPubMedSuche in Google Scholar
  • 28 Kamada H, Yu F, Nito C, Chan PH. Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats: relation to blood-brain barrier dysfunction. Stroke 2007; 38 (03) 1044-1049
    CrossrefPubMedSuche in Google Scholar
  • 29 Kruyt ND, Biessels GJ, DeVries JH. et al. Hyperglycemia in aneurysmal subarachnoid hemorrhage: a potentially modifiable risk factor for poor outcome. J Cereb Blood Flow Metab 2010; 30 (09) 1577-1587
    CrossrefPubMedSuche in Google Scholar
  • 30 Song EC, Chu K, Jeong SW. et al. Hyperglycemia exacerbates brain edema and perihematomal cell death after intracerebral hemorrhage. Stroke 2003; 34 (09) 2215-2220
    CrossrefPubMedSuche in Google Scholar
  • 31 Atchaneeyasakul K, Tipirneni A, Zhang T. et al. Association of hypothyroidism with unruptured cerebral aneurysms: a case-control study. J Neurosurg 2018; 128 (02) 511-514
    CrossrefPubMedSuche in Google Scholar