| Abstract [eng] |
Introduction. Aneurysmal subarachnoid hemorrhage is a life-threatening condition associated with extremely high mortality and long-term disability. The aim of this study is to identify factors that allow early prediction of outcome in patients who have a ruputured intracranial aneurysm. Methods. A retrospective analysis was performed using data from patients treated for aneurysmal subarachnoid hemorrhage at Vilnius University Hospital Santaros Clinics from September 2021 to December 2022. The following data was collected from patients‘ medical histories: patient‘s age, gender, time from aneurysm rupture to admission and from admission to neurosurgical operation, what treatment was used, first day‘s results of laboratory tests (hemoglobin, platelets, C-reactive protein, sodium, glucose, lactate, d-dimers), radiological imaging data – aneurysm size, localization, subarachnoid hemorrhage extent, radiological vasospasm, delayed cerebral ischemia, cerebral edema, modified Fisher Scale, Glasgow Coma Scale and Glasgow outcome scale scores. Two outcomes were analyzed – the primary outcome (death) and the secondary outcome (poor outcome) and their association with the above-mentioned indicators. Also, the association of laboratory markers with the development of complications was analysed and correlation analysis was performed using statistical data analysis methods. Results were considered statistically significant when p was < 0.05. Results. The study included 25 patients (64% women), with a mean age of 57.32 ± 14.22 years. The mortality analysis showed that the glucose concentration on the first day was statistically significantly higher in the deceased patients’ group (10.42 ± 1.76 mmol/L) compared to the group of survivors (7.65 ± 1.83 mmol/L), p = 0.006. It was found that certain localizations of bleeding after aneurysm rupture were significantly associated with mortality – the quadrigeminal area (p = 0.023), cistern of velum interpositum (p = 0.015), superior cerebellar cistern (p = 0.031) and the convexity subarachnoid space on the right side (p = 0.02). A strong connection was found between poor outcome and the development of radiological vasospasm (p = 0.003; especially if there was a spasm of two or more arteries – p = 0.0198) and the development of delayed cerebral ischemia (p = 0.0002). It was found that the concentration of C-reactive protein was statistically significantly associated with the development of both cerebral vasospasm (p = 0.021) and delayed cerebral ischemia (p = 0.018). Also, there was a positive correlation of Glasgow Outcome Scale with the Glasgow Coma Scale (p = 0.031), a negative correlation with the modified Fisher Scale (p = 0.032) and a negative correlation with subarachnoid hemorrhage cistern size (p = 0.027). Conclusion. The outcome of aneurysmal subarachnoid hemorrhage in the studied patient sample directly depends on Glasgow Coma Scale and modified Fisher Scale scores and the location of the bleeding. The development of cerebral vasospasm and delayed cerebral ischemia is associated with poor clinical outcome. C-reactive protein concentration on the first day could predict the development of cerebral vasospasm and delayed cerebral ischemia. |
