J Neurol Surg A Cent Eur Neurosurg 2017; 78(S 01): S1-S22
DOI: 10.1055/s-0037-1603834
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Georg Thieme Verlag KG Stuttgart · New York

Predictors of in-Hospital Death Following Aneurysmal Subarachnoid Hemorrhage – Analysis of a Nationwide Database (Swiss SOS)

M.N. Stienen
1   UniversitätsSpital Zürich, Zürich, Switzerland
,
J. Burkhardt
1   UniversitätsSpital Zürich, Zürich, Switzerland
,
M.C. Neidert
1   UniversitätsSpital Zürich, Zürich, Switzerland
,
C. Fung
2   Inselspital, Universitätsspital Bern, Bern, Switzerland
,
D. Bervini
2   Inselspital, Universitätsspital Bern, Bern, Switzerland
,
D. Zumofen
3   Universitätsspital Basel, Basel, Switzerland
,
S. Marbacher
4   Kantonsspital Aarau AG, Aarau, Switzerland
,
R. Maduri
5   CHUV Lausanne, Lausanne, Switzerland
,
D. Valsecchi
6   Ente Ospedaliero Cantonale, Bellinzona, Switzerland
,
M.A. Seule
7   Kantonsspital St. Gallen, St. Gallen, Switzerland
,
P. Bijlenga
8   Hôpitaux Universitaires de Genève, Genève, Switzerland
,
S. Bawarjan
9   University Medical Center Göttingen, Göttingen, Germany
,
K. Schaller
8   Hôpitaux Universitaires de Genève, Genève, Switzerland
,
E. Keller
1   UniversitätsSpital Zürich, Zürich, Switzerland
,
O. Bozinov
1   UniversitätsSpital Zürich, Zürich, Switzerland
,
L. Regli
1   UniversitätsSpital Zürich, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

Publication Date:
02 June 2017 (online)

 

Aims: To identify predictors of in-hospital mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: Retrospective analysis of prospective nationwide data from a multicenter registry on all aSAH cases admitted to a tertiary neurosurgical department in Switzerland between 2009 – 2014 (Swiss SOS). Patients admitted alive but dead at discharge (in-hospital mortality) were identified and both clinical and radiological predictors of death (adjusted odds ratios (aOR)) were identified using multivariate logistic regression analysis.

Results: Of n = 1866 patients admitted alive with aSAH, in-hospital mortality was 20.0% (n = 373) with death occurring within 48h of ictus in 35.7% (n = 133). Independent predictors of in-hospital mortality at admission were uni- or bilateral pupil dilatation (aOR 3.68, 95% CI 2.33–5.83, p < 0.001), followed by high WFNS grade (4 and 5; aOR 3.02, 95% CI 1.99–4.58, p < 0.001), presence of intraventricular hemorrhage (aOR 2.66, 95% CI 1.73–4.09, p < 0.001), age ≥ 60 years (aOR 1.99, 95% CI 1.36–2.89, p < 0.001), and midline shift (aOR 1.61, 95% CI 1.03–2.53, p = 0.039). Male patients were as likely as female patients to die (aOR 1.34, 95% CI 0.90–1.98, p = 0.149). Patients not receiving curative therapy were more likely to die (aOR 14.11, 95% CI 9.16–21.73, p < 0.001), as were patients with aneurysm re-bleeding (aOR 8.21, 95% CI 4.25–15.86, p < 0.001), and those experiencing delayed cerebral ischemia (aOR 2.93, 95% CI 1.91–4.50, p < 0.001). The rates of in-hospital mortality were 11.02% after a clipping and 12.55% after a coiling procedure. Finally, infarction on post-treatment CT scan was another predictor of death (OR 2.09, 95% CI 1.51–2.89, p < 0.001).

Conclusions: The unselected nationwide database allows for accurate determination of the effect size of important predictors of in-hospital mortality. High independent predictors were re-bleeding (aOR 8.21), pupil dilatation at admission (aOR 3.68) and high WFNS grade (aOR 3.02).