Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage

Neurocrit Care. 2007;7(1):18-26. doi: 10.1007/s12028-007-0053-5.

Abstract

Objective: To describe features in patients admitted to the intensive care unit (ICU) for poor-grade aneurysmal subarachnoid hemorrhage (SAH) and to identify predictors of 12-month outcome.

Methods: We conducted a controlled observational study of 51 consecutive patients treated with endovascular coiling within 96 h of rupture for poor-grade aneurysmal SAH (20 men and 31 women, age 54 +/- 12 years). We recorded co-morbidities; initial severity; aneurysm location; occurrence of acute hydrocephalus, initial seizures, and/or neurogenic lung edema; troponin values, Fisher grade; computed tomography (CT) findings; treatment intensity; and occurrence of vasospasm. The brain injury marker S100B was assayed daily over the first 8 days. Glasgow Outcome Scores (GOS) were recorded at ICU discharge, at 6 and 12 months. The main outcome criterion was the 1-year GOS score, which we used to classify patients as having a poor outcome (GOS 1-3) or a good outcome (GOS 4-5).

Results: Overall, clinical status after 1 year was very good (GOS 5) in 41% of patients and good (GOS 4) in 16%. Neither baseline characteristics nor interventions differed significantly between patients with good outcome (GOS 4-5) and those with poor outcome (GOS 1-3). Persistent intracranial pressure elevation and higher mean 8-day S100B value significantly and independently predicted the 1-year GOS outcome (P = 0.008 and P = 0.001, respectively).

Conclusions: Patients in poor clinical condition after SAH have more than a 50:50 chance of a favorable outcome after 1 year. High mean 8-day S100B value and persistent intracranial hypertension predict a poor outcome (GOS 1-3) after 1 year.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Critical Care*
  • Embolization, Therapeutic*
  • Female
  • Follow-Up Studies
  • Glasgow Outcome Scale
  • Humans
  • Male
  • Middle Aged
  • Nerve Growth Factors / blood
  • Predictive Value of Tests
  • Retrospective Studies
  • S100 Calcium Binding Protein beta Subunit
  • S100 Proteins / blood
  • Subarachnoid Hemorrhage / blood
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / therapy*
  • Time Factors
  • Treatment Outcome

Substances

  • Nerve Growth Factors
  • S100 Calcium Binding Protein beta Subunit
  • S100 Proteins
  • S100B protein, human