Impact of Clinical Variables and Aneurysm Morphology on Hemorrhage Volume and Clinical Outcomes.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-06-16 DOI:10.1227/neu.0000000000003567

Andres Gudino, Elena Sagues, Carlos Dier, Sebastian Sanchez, Martin Cabarique, Navami Shenoy, Alexander Van Dam, Linder Wendt, Connor Aamot, Santiago Ortega-Gutierrez, Mario Zanaty, Edgar A Samaniego

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引用次数: 0

Abstract

Background and objectives: It is unknown what determines the volume of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate the features associated to the burden of subarachnoid hemorrhage after aneurysm rupture and its impact on clinical outcomes.

Methods: Patients admitted with aSAH between 2009 and 2022 were included. Clinical data were obtained from electronic medical records. Aneurysm location and morphological measurements were assessed using digital subtraction angiography. aSAH volume was objectively quantified on admission noncontrast computed tomography using semiautomated software. Univariate and multivariate analyses were performed to identify predictors of hemorrhage volume and examine its association with delayed cerebral ischemia (DCI), clinical vasospasm, and 7-day mortality in younger (18-64 years) and elderly (≥65 years) patients.

Results: Two hundred ruptured intracranial aneurysms were analyzed. Ruptured bifurcating aneurysms exhibited larger hemorrhage volume compared with sidewall aneurysms (23.16 mL, IQR: 34.2 vs 11.95 mL, IQR: 20.9, P = .002). In multivariate analysis, age (exp β 1.02; 95% CI 1.01-1.03; P < .001), Hunt and Hess (exp β 1.46, 95% CI: 1.31-1.62, P <.001), and bifurcation aneurysms (exp β 1.76; 95% CI 1.37-2.26; P <.001) were correlated with increased aSAH volume. Among younger patients, higher aSAH volume was associated with DCI (odds ratio [OR] 1.04; 95% CI 1.02-1.06; P < .001), clinical vasospasm (OR 1.02; 95% CI 1.01-1.03; P = .02), and 7-day mortality (OR 1.05; 95% CI 1.02-1.07; P < .001). In elderly population, larger aSAH was only associated with 7-day mortality (OR 1.04; 95% CI 1.01-1.07; P = .01).

Conclusion: Older age, bifurcating aneurysms, and higher Hunt and Hess are associated with larger aSAH volumes. In younger patients, greater aSAH volume is linked to an increased risk of DCI, clinical vasospasm, and 7-day mortality. Among older patients, increased aSAH volume is only associated with 7-day mortality.

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临床变量和动脉瘤形态对出血量和临床结果的影响。

背景和目的：动脉瘤性蛛网膜下腔出血（aSAH）的体积是由什么决定的尚不清楚。我们的目的是研究动脉瘤破裂后蛛网膜下腔出血负担的相关特征及其对临床结果的影响。方法：纳入2009年至2022年间入院的aSAH患者。临床资料来源于电子病历。采用数字减影血管造影评估动脉瘤位置和形态学测量。在入院时使用半自动软件对aSAH体积进行客观量化。进行单因素和多因素分析，以确定出血量的预测因素，并检查其与年轻（18-64岁）和老年（≥65岁）患者延迟性脑缺血（DCI）、临床血管痉挛和7天死亡率的关系。结果：对200例颅内破裂动脉瘤进行了分析。分岔动脉瘤破裂出血量比侧壁动脉瘤大（23.16 mL, IQR: 34.2 vs 11.95 mL, IQR: 20.9, P = 0.002）。在多变量分析中，年龄(exp β 1.02；95% ci 1.01-1.03；P < 0.001)， Hunt和Hess （exp β 1.46, 95% CI: 1.31-1.62， P）结论：年龄越大，分叉性动脉瘤和较高的Hunt和Hess与aSAH体积越大有关。在年轻患者中，更大的aSAH容量与DCI、临床血管痉挛和7天死亡率的风险增加有关。在老年患者中，aSAH体积增加仅与7天死亡率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.