Journal of Shandong University (Health Sciences) ›› 2022, Vol. 60 ›› Issue (9): 97-101.doi: 10.6040/j.issn.1671-7554.0.2022.1378

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Factors of preoperative rebleeding in 181 patients with poor-grade aneurysmal subarachnoid hemorrhage

XU Kai1, HAN Chao2, DING Shouluan3, DING Xuan2, XING Deguang2, WANG Chengwei2   

  1. 1. The Second Hospital of Shandong University, Jinan 250033, Shandong, China;
    2. Department of Neurosurgery, The Second Hospital of Shandong University, Jinan 250033, Shandong, China;
    3. Center of Evidence-Based Medicine, Institute of Medical Sciences, The Second Hospital of Shandong University, Jinan 250033, Shandong, China
  • Published:2022-09-02

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Abstract: Objective To investigate the influencing factors of rebleeding in patients with poor-grade aneurysmal subarachnoid hemorrhage(aSAH). Methods A total of 181 patients who met the World Federation of Neurosurgical Societies(WFNS)grade IV or V criteria were enrolled in this retrospective cohort study. The patients were divided into rebleeding group(n=26)and non-rebleeding group(n=155). Case-control study analysis was used to compare the demographic characteristics, medical history, clinical status, WFNS grade, CT Fisher grade, aneurysm characteristics, treatment timing and outcomes at 6 months between the two groups. Results Preoperative relleeding was observed in 26 of 181 cases. There were no significant statistical differences between the two groups in gender, age, medical history(hypertension, diabetes and obesity), personal history(smoking and drinking), clinical status(cerebral hernia, intracerebral hematoma, low density area and hydrocephalus)and radiological characteristics(aneurysm location, aneurysm size, multiple aneurysms). In the rebleeding group, 13 cases had intraventricular hemorrhage, 15 cases were of WFNS grade V, 25 cases were of CT Fisher grade 3-4, and the differences were statistically significant compared with those in the non-rebleeding group. Multivariate analysis showed that intraventricular hemorrhage(OR=3.804, 95%CI: 1.161-12.462, P=0.027)was an independent risk factor for rebleeding. In the rebleeding group, 20 cases(76.92%)had poor prognosis(mRS 3-6), and the mortality rate was 26.9%. The difference was statistically significant compared with that in the non-rebleeding group. Unfavorable outcomes occurred more often in the rebleeding group. Conclusion IVH, WFNS grade V and CT Fisher grade 3-4 are associated with rebleeding. Demographic characteristics, medical history, clinical status, treatment timing, external ventricular drainage(EVD)or aneurysm characteristics are not significantly associated with rebleeding.

Key words: Intracranial aneurysm, Subarachnoid hemorrhage, Rebleeding, Influencing factors

CLC Number: 

  • R651
[1] Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage[J]. Stroke, 2010, 41(8): e519-536. doi: 10.1161/STROKEAHA.110.581975.
[2] Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2012, 43(6): 1711-1737.
[3] Rinkel GJ, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage[J]. Lancet Neurol, 2011, 10(4): 349-356.
[4] Zhao B, Fan Y, Xiong Y, et al. Aneurysm rebleeding after poor-grade aneurysmal subarachnoid hemorrhage: Predictors and impact on clinical outcomes[J]. Neurol Sci, 2016, 371: 62-66. doi:10.1016/j.jns.2016.10.020.
[5] Germans MR, Coert BA, Vandertop WP, et al. Time intervals from subarachnoid hemorrhage to rebleed[J]. Neurol, 2014, 261(7): 1425-1431.
[6] Wu TC, Tsui YK, Chen TY, et al. Rebleeding of aneurysmal subarachnoid hemorrhage in computed tomography angiography: risk factor, rebleeding pattern, and outcome analysis[J]. J Comput Assist Tomogr, 2012, 36(1): 103-108.
[7] Starke RM, Connolly ES Jr. Participants in the international multi-disciplinary consensus conference on the critical care management of subarachnoid hemorrhage. rebleeding after aneurysmal subarachnoid hemorrhage[J]. Neurocrit Care, 2011, 5(2): 241-246.
[8] Osgood ML. Aneurysmal subarachnoid hemorrhage: review of the pathophysiology and management strategies[J]. Curr Neurol Neurosci Rep, 2021, 21(9): 50.
[9] Guo LM, Zhou HY, Xu JW, et al. Risk factors related to aneurismal rebleeding[J]. World Neurosurg, 2011, 76(3-4): 292-298.
[10] De Marchis GM, Lantigua H, Schmidt JM, et al. Impact of premorbid hypertension on haemorrhage severity and aneurysm rebleeding risk after subarachnoid haemorrhage[J]. J Neurol Neurosurg Psychiatry, 2014, 85(1): 56-59.
[11] Koopman I, Greving JP, van der Schaaf IC, et al. Aneurysm characteristics and risk of rebleeding after subarachnoid haemorrhage[J]. Eur Stroke J, 2019, 4(2): 153-159.
[12] Cha KC, Kim JH, Kang HI, et al. Aneurysmal rebleeding: factors associated with clinical outcome in the rebleeding patients[J]. J Korean Neurosurg Soc, 2010, 47(2): 119-123.
[13] Cagnazzo F, Gambacciani C, Morganti R, et al. Aneurysm rebleeding after placement of external ventricular drainage: a systematic review and meta-analysis[J]. Acta Neurochir(Wien), 2017, 159(4): 695-704.
[14] Cong W, Zhongxin Z, Tiangui L, et al. Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage based on the analysis of on-admission information[J]. Turk Neurosurg, 2012, 22(6): 675-681.
[15] Linzey JR, Williamson C, Rajajee V, et al. Twenty-four-hour emergency intervention versus early intervention in aneurysmal subarachnoid hemorrhage[J]. J Neurosurg, 2018, 128(5): 1297-1303.
[16] Roelz R, Grauvogel J, Csok I, et al. Patterns of intracerebral hemorrhage that result in unfavorable outcomes in patients with subarachnoid hemorrhage[J]. Clin Neurol Neurosurg, 2021, 205: 106603. doi: 10.1016/j.clineuro.2021.106603.
[17] Cooper JG, Smith B, Hassan TB. A retrospective review of sudden onset severe headache and subarachnoid haemorrhage on the clinical decision unit: looking for a needle in a haystack[J]. Eur J Emerg Med, 2016, 23(5): 356-362.
[18] Huang AP, Arora S, Wintermark M, et al. Perfusion computed tomographic imaging and surgical selection with patients after poor-grade aneurysmal subarachnoid hemorrhage[J]. Neurosurgery, 2010, 67(4): 964-974.
[19] 王立江, 段传志, 何旭英, 等. 血管内栓塞治疗颅内小动脉瘤性蛛网膜下腔出血预后的研究[J]. 山东大学学报(医学版), 2010, 48(2): 94-100. WANG Lijiang, DUAN Chuanzhi, HE Xuying, et al. Prognosis of subarachnoid hemorrhage due to small ruptured intracranial aneurysms treated by guglielmi detachable coils endovascular embolization[J]. Journal of Shandong University(Health Sciences), 2010, 48(2): 94-100.
[20] Sandström N, Yan B, Dowling R, et al. Comparison of microsurgery and endovascular treatment on clinical outcome following poor-grade subarachnoid hemorrhage[J]. J Clin Neurosci, 2013, 20(9): 1213-1218.
[21] Tang C, Zhang TS, Zhou LF. Risk factors for rebleeding of aneurysmal subarachnoid haemorrhage: a meta-analysis[J]. PLoS One, 2014, 9(6): e99536. doi: 10.1371/journal.pone.0099536.
[22] Bederson JB, Connolly ES Jr, Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association[J]. Stroke, 2009, 40(3): 994-1025.
[23] Szklener S, Melges A, Korchut A, et al. Predictive model for patients with poor-grade subarachnoid haemorrhage in 30-day observation: a 9-year cohort study[J]. BMJ Open, 2015, 5(6): e007795. doi: 10.1136/bmjopen-2015-007795.
[24] Viarasilpa T, Ghosh P, Gidwani S, et al. Prognostic significance of sentinel headache preceding aneurysmal subarachnoid hemorrhage[J]. World Neurosurg, 2020, 139: e672-e676. doi: 10.1016/j.wneu.2020.04.097.
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