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Master Thesis

Predictors of good outcome in good grade subarachnoid hemorrhage

Abstract : Background: The management of Subarachnoid hemorrhage (SAH) has improved in recent years with lower mortality but morbidity remains high. Several studies have focused on predictors of poor outcome in all grades SAH. Information about good grade SAH is scarce. The aim of this study was to determine predictors of good outcome after good grade SAH to potentially modify their management. Methods: We conducted a retrospective analysis of all patients admitted in neurosurgical ICU in 2012 for SAH with WFNS (World Federation of Neurologic Surgeons) score between 1 and 3. We focused on predictor of SAH complications: vasospasm, rebleeding and hydrocephalus, and 1-year functional outcome. A good outcome was defined by Glasgow Outcome Scale ≥ 5 at 1-year. Univariate analysis of possible risk factors was performedwith subsequent multivariate logistic regression analysis. A P value < 0.05 was considered significant. Results: Within the 92 patients included, 34 presented a complication during hospitalization: 30 (32.6 %) transcranial Doppler vasospasm, 16 (17.4%) symptomatic vasospasm, 5 (5.4%) rebleeding, 15 (16.3%) hydrocephalus, 9 (9.7%) seizures and 7 (7.6%) sepsis. Vasospasm was correlated to WFNS (p < 0.0001) and Fishergrade (p = 0.0296) at admission, rebleeding (p = 0.0374), higher temperature during the first week (p = 0.0031). Hydrocephalus was associated with higher WFNS grade at admission.An excellent outcome was found in 57 (72%) patients. In multivariate analyses, no transcranial Doppler vasospasm (OR = 6.38 [1.57; 25.84], p =0.0094) and no seizure (OR = 9.99 [1.19; 83.63], p = 0.0337) were associated with a good functional outcome at 1 year (GOS≥5). Conclusion: In our study, patients with good grade SAH had a good functional outcome. Only vasospasm on transcranial Doppler and seizure were associated with poor outcome. The question of intensive monitoring and resuscitation in patients presenting a vasospasm on transcranial Doppler without any clinical symptoms still needs to be assessed.
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https://dumas.ccsd.cnrs.fr/dumas-01754710
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Submitted on : Wednesday, June 6, 2018 - 12:09:48 PM
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Amandine Le Gall. Predictors of good outcome in good grade subarachnoid hemorrhage. Life Sciences [q-bio]. 2016. ⟨dumas-01754710⟩

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