Background: Mortality rates of up to 40% in the early phase following an aneurysmal subarachnoid haemorrhage (SAH) indicate that the overall case-fatality rate is predominantly influenced by the initial phase of the disease. This analysis investigates the in-hospital causes of death (CODs) within 30 days of admission in patients suffering from a SAH.
Methods: Of the 591 consecutive patients with SAHs from ruptured cerebral aneurysms, 85 patients who died within 30 days after admission were analysed. The various CODs were classified as cerebral or non-cerebral events. A Kaplan-Meier survival analysis was performed for the cerebral and non-cerebral CODs to identify the specific chronology of occurrence.
Results: The median cumulative fatality was 4 days. A cerebral oedema as a result of initial brain damage after ictus was the predominant COD (n=24, 28.2%; median cumulative fatality, 1 day; IQR, 1-4 days; SEM, 0.680), followed by cerebral infarction caused by delayed cerebral ischaemia (DCI) (n=13, 15.3%; median cumulative fatality, 9 days; IQR, 4-13 days; SEM, 1.379). Renal failure was the predominant non-cerebral COD before cardiac and pulmonary complications (n=6, 7.1%).
Conclusions: Mortalities after SAHs predominantly occur within the first days after ictus. The dominant cerebral cause of death is early initial cerebral oedema, followed by DCI.
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