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A National Cohort with Aneurysmal Subarachnoid Hemorrhage—Patient Characteristics, Choice of Treatment, Clinical Outcome, and Factors of Prognostic Importance

Aineskog, Helena ; Baldvinsdóttir, Bryndís LU ; Ronne Engström, Elisabeth ; Eneling, Johanna ; Enblad, Per ; Svensson, Mikael ; Alpkvist, Peter ; Fridriksson, Steen ; Klurfan, Paula and Hillman, Jan , et al. (2024) In World Neurosurgery 190. p.513-524
Abstract

Objective: To study associations of clinical characteristics and treatment choice with functional outcome, mortality, and time to death in a national sample of aneurysmal subarachnoidal hemorrhage patients. Methods: Data were extracted from a prospective nationwide multicenter study performed in September 2014 to March 2018. Glasgow Outcome Scale Extended (GOSE) grade, 1-year mortality, and survival probability were assessed at one year after ictus. Logistic univariate, multivariate, and Cox regression analyses were used to study the variables' associations with the outcomes. Results: Unfavorable dichotomized GOSE (dGOSE; grades 1–4) was observed in 35.4% of patients. Microsurgery was preferred for middle cerebral artery aneurysms and... (More)

Objective: To study associations of clinical characteristics and treatment choice with functional outcome, mortality, and time to death in a national sample of aneurysmal subarachnoidal hemorrhage patients. Methods: Data were extracted from a prospective nationwide multicenter study performed in September 2014 to March 2018. Glasgow Outcome Scale Extended (GOSE) grade, 1-year mortality, and survival probability were assessed at one year after ictus. Logistic univariate, multivariate, and Cox regression analyses were used to study the variables' associations with the outcomes. Results: Unfavorable dichotomized GOSE (dGOSE; grades 1–4) was observed in 35.4% of patients. Microsurgery was preferred for middle cerebral artery aneurysms and Fisher grade 4. Treatment modality was not associated with any outcome measure. Dichotomized World Federation of Neurosurgical Societies (dWFNS), age, and delayed ischemic neurological deficit (DIND) showed significant correlations with dGOSE and 1-year mortality in multivariate regression analyses. Pupil dilatation was associated with a 1-year mortality outcome. Cox regression analysis showed lower survival probability for pupil dilatation (hazard ratio [HR]: 3.546), poor dWFNS (HR: 3.688), higher age (HR: 1.051), and DIND occurrence (HR: 2.214). Conclusions: The patient selection in Sweden after aneurysmal subarachnoidal hemorrhage showed similar values for dGOSE, 1-year mortality, and survival probability between patients treated with microsurgery or endovascular technique. Poor dWFNS, higher age, and DIND were significantly associated with unfavorable dGOSE, mortality, and survival probability. Pupil dilatation was significantly associated with mortality and survival probability.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Clipping, Coiling, Glasgow Outcome Scale Extended, Subarachnoid hemorrhage, WFNS
in
World Neurosurgery
volume
190
pages
513 - 524
publisher
Elsevier
external identifiers
  • pmid:39084286
  • scopus:85202039011
ISSN
1878-8750
DOI
10.1016/j.wneu.2024.07.164
language
English
LU publication?
yes
id
8b47a103-37fe-4124-8d81-ca9e441cfa03
date added to LUP
2024-10-30 15:25:07
date last changed
2024-10-30 15:25:42
@article{8b47a103-37fe-4124-8d81-ca9e441cfa03,
  abstract     = {{<p>Objective: To study associations of clinical characteristics and treatment choice with functional outcome, mortality, and time to death in a national sample of aneurysmal subarachnoidal hemorrhage patients. Methods: Data were extracted from a prospective nationwide multicenter study performed in September 2014 to March 2018. Glasgow Outcome Scale Extended (GOSE) grade, 1-year mortality, and survival probability were assessed at one year after ictus. Logistic univariate, multivariate, and Cox regression analyses were used to study the variables' associations with the outcomes. Results: Unfavorable dichotomized GOSE (dGOSE; grades 1–4) was observed in 35.4% of patients. Microsurgery was preferred for middle cerebral artery aneurysms and Fisher grade 4. Treatment modality was not associated with any outcome measure. Dichotomized World Federation of Neurosurgical Societies (dWFNS), age, and delayed ischemic neurological deficit (DIND) showed significant correlations with dGOSE and 1-year mortality in multivariate regression analyses. Pupil dilatation was associated with a 1-year mortality outcome. Cox regression analysis showed lower survival probability for pupil dilatation (hazard ratio [HR]: 3.546), poor dWFNS (HR: 3.688), higher age (HR: 1.051), and DIND occurrence (HR: 2.214). Conclusions: The patient selection in Sweden after aneurysmal subarachnoidal hemorrhage showed similar values for dGOSE, 1-year mortality, and survival probability between patients treated with microsurgery or endovascular technique. Poor dWFNS, higher age, and DIND were significantly associated with unfavorable dGOSE, mortality, and survival probability. Pupil dilatation was significantly associated with mortality and survival probability.</p>}},
  author       = {{Aineskog, Helena and Baldvinsdóttir, Bryndís and Ronne Engström, Elisabeth and Eneling, Johanna and Enblad, Per and Svensson, Mikael and Alpkvist, Peter and Fridriksson, Steen and Klurfan, Paula and Hillman, Jan and Kronvall, Erik and Nilsson, Ola G. and Lindvall, Peter}},
  issn         = {{1878-8750}},
  keywords     = {{Clipping; Coiling; Glasgow Outcome Scale Extended; Subarachnoid hemorrhage; WFNS}},
  language     = {{eng}},
  pages        = {{513--524}},
  publisher    = {{Elsevier}},
  series       = {{World Neurosurgery}},
  title        = {{A National Cohort with Aneurysmal Subarachnoid Hemorrhage—Patient Characteristics, Choice of Treatment, Clinical Outcome, and Factors of Prognostic Importance}},
  url          = {{http://dx.doi.org/10.1016/j.wneu.2024.07.164}},
  doi          = {{10.1016/j.wneu.2024.07.164}},
  volume       = {{190}},
  year         = {{2024}},
}