Thirty-day mortality in the oldest old with spontaneous subarachnoid hemorrhage

Abstract

Objective

Spontaneous subarachnoid hemorrhage (SAH) is a severe disease with a high mortality rate that frequently occurs in the elderly. People aged 80 years and over can be regarded as the oldest old and are a rapidly growing segment of the population. It is unknown whether aggressive intervention for SAH is beneficial in this age cohort. We aimed to analyze the incidence and risk factors of 30-day mortality in the oldest old after spontaneous SAH.

Methods

A total of 1689 adult patients with a primary diagnosis of spontaneous SAH were retrospectively enrolled. Differences in clinical variables were evaluated between patients aged 18–79 years (N = 1592) and those aged ≥80 years (N = 97).

Results

The oldest old comprised 5.7 % of the study population. The 30-day mortality rate was 43.3 % (42/97) in the oldest old patients and 28.8 % (459/1592) in the non-oldest old patients (p < 0.01). In a multivariate logistic regression model, the independent risk factor for 30-day mortality in the oldest old was hydrocephalus [odds ratio (95 % confidence interval) = 6.12 (1.54–24.25); p = 0.01]. The 30-day mortality rate was up to 58.3 % (21/36) among the oldest old patients accompanied by hydrocephalus.

Conclusions

The oldest old account for a significant proportion of patients with spontaneous SAH. As the incidence of 30-day mortality is remarkably high in this age group, the decision to aggressively treat the oldest old with SAH requires careful weighing, particularly in those who are highly risky.