AUTHOR=Scibilia Antonino , Rustici Arianna , Linari Marta , Zenesini Corrado , Belotti Laura Maria Beatrice , Dall’Olio Massimo , Princiotta Ciro , Cuoci Andrea , Aspide Raffaele , Migliorino Ernesto , Moneti Manuel , Sturiale Carmelo , Castioni Carlo Alberto , Conti Alfredo , Bortolotti Carlo , Cirillo Luigi 

TITLE=Factors affecting 30-day mortality in poor-grade aneurysmal subarachnoid hemorrhage: a 10-year single-center experience

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1286862

DOI=10.3389/fneur.2024.1286862

ISSN=1664-2295

ABSTRACT=The management of patients with poor grade aneurysmal subarachnoid hemorrhage (aSAH) is burdened by an unfavorable prognosis even with aggressive treatments. The aim of the present study is to investigate the risk factors affecting 30 days mortality in poorgrade aSAH patients. Methods: We performed a retrospective analysis on a prospectively collected database of poor-grade aSAH patients (World Federation of Neurosurgical Societies, WFNS, grade IV and V) treated at our institution from December 2010 to December 2020. For all variables, percentages of frequency distributions were analyzed. Contingency tables (Chi-square test) were used to assess the association between categorical variables and outcome in the univariable analysis. Multivariable analysis was performed by using the multiple logistic regression method to estimate the odds ratio (OR) for 30-days mortality. Results: A total of 149 patients were included of which 32% were WFNS grade 4 and 68% were WFNS grade 5. The overall 1-month mortality rate was 21%. On univariable analysis, five variables were found to be associated with the likelihood of death, including intraventricular hemorrhage (IVH ≥ 50ml, p=0.005), the total amount of intraventricular and intraparenchymal hemorrhage (IVH+ICH ≥ 90ml, p=0.019), the IVH Ratio (IVH Ratio ≥ 40%, p=0.003), posterior circulation aneurysms (p=0.019), spot sign presence on initial CT scan angiography (p=0.015). Nonetheless, when multivariable analysis was performed, 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) turned out to be independent predictors of 30 days mortality. Conclusions: Risk for death in poor grade aSAH remains considerable despite maximal treatment. Notwithstanding the limitations of a retrospective study, our report points out some neuroradiological features that in the setting of emergency, combined with leading clinical and anamnestic parameters, may support the multidisciplinary team in the difficult decision-making process and communication with family members from the earliest stages of poor grade aSAH. Further prospective studies are warranted.