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
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