The following is a summary of “Factors affecting 30-day mortality in poor-grade aneurysmal subarachnoid hemorrhage: a 10-year single-center experience,” published in the February 2024 issue of Neurology by Scibilia et al.

Despite aggressive approaches, treating poor-grade aneurysmal subarachnoid hemorrhage (aSAH) remains challenging due to its grim outlook.

Researchers conducted a retrospective study to pinpoint risk factors influencing 30-day mortality in poor-grade aSAH patients.

They analyzed a database containing poor-grade aSAH patients (classified according to the World Federation of Neurosurgical Societies (WFNS) as grades IV and V) treated (December 2010 to December 2020). Frequency distributions for all variables were analyzed. The univariable analysis assessed the association between categorical variables and outcomes using contingency tables (Chi-squared test). Multiple logistic regression was utilized for the multivariable analysis to estimate the OR for 30-day mortality.

The results showed that of 149 patients, 32% had WFNS grade 4, and 68% had WFNS grade 5. The overall 1-month mortality rate stood at 21%. The univariable analysis identified five variables associated with death likelihood, including IVH ≥ 50 mL (P=0.005), IVH + ICH ≥ 90 mL (P=0.019), IVH Ratio ≥ 40% (P=0.003), posterior circulation aneurysms (P=0.019), and spot sign presence on CT scan angiography (P=0.015). However, in multivariable analysis, only IVH Ratio (P=0.005; OR 3.97), posterior circulation aneurysms (P=0.008; OR 4.05), and spot sign (P=0.022; OR 6.87) emerged as independent predictors of 30-day mortality.

Investigators concluded that high mortality persists in poor-grade aSAH despite aggressive treatment. Emergent neuroimaging findings may offer additional insights for decision-making, requiring further prospective studies.

Source: frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1286862/full