Effect of Comorbidities on the Outcome of Patients with Aneurysmal SAH: A Prospective Observational Study

Keywords

SAH - CAD - DM - MRS

Introduction: Subarachnoid hemorrhage (SAH) carries a high mortality of 30 to 40%. Among survivors, 40 to 50% suffer disability and cognitive decline. Comorbidities can have a contribution in the disease process. With this background, we hypothesize that comorbidities in a patient with aneurysmal SAH can influence the course of disease and thereby the neurological outcome.

Methodology/Description: This prospective observational study was commenced after ethics committee clearance and written informed consent. We enrolled 89 (59 females and 30 males) consecutive patients of aneurysmal SAH, scheduled for clipping/coiling from July 2016 to October 2017. Patients’ comorbidities were recorded and outcome followed in postoperative period using MRS at discharge and MRS and GOS at 1 month after discharge. Analysis was done using chi square test.

Results: In patients undergoing clipping, smoking was associated with worse outcome (0.01). Smoking and alcohol intake was associated with increased incidence of vasospasm, infarct, and rebleed ([0.02 and 0.04], [0.001 and 0.003], [0.02 and 0.04], respectively). In patients undergoing coiling, CAD was associated with worse outcome (0.02), increased incidence of rebleed (0.007), and hydrocephalus (0.03). Smoking, alcohol intake, and DM were associated with increased incidence of vasospasm (0.014, 0.04, and 0.04, respectively). Smoking was also associated with increased incidence of rebleed (0.005). Hypertension, thyroid dysfunction, TB, and joint disease were not associated with worse outcome or increased incidence of complications.

Conclusion: Various comorbidities, including DM, CAD, smoking, and alcohol intake, were associated with increased risk of perioperative complications in patients after SAH. Other comorbidities, such as hypertension, thyroid dysfunction, TB, and joint disease, neither affect outcome nor increase risk of complications.

• References

• 1 Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage.. Stroke 2007; 38 (08) 2315-2321