Funktionelle Verbesserung bei Überlebenden mit schlechtem Ausgang bei der Entlassung nach aneurysmatischer Subarachnoidalblutung: eine gepoolte Analyse

Aneurysmal subarachnoid hemorrhage (aSAH) carries a substantial risk of poor outcome with long-term functional limitations. However, in some cases improvement is possible despite poor neurological condition at discharge. In this pooled analysis, we observed the improvements in neurological status in aSAH patients surviving the acute phase with a poor condition (modified Rankin Scale [mRS] = 4 – 5).

From a pooled database of two German university hospitals with aSAH (n=1171), the sub-cohort of survivors with poor condition at discharge was selected (n=454). Baseline demographic, clinical and radiographic parameters and outcome-relevant adverse events during aSAH were collected. The probability of favorable outcome (mRS≤3) and functional independency (mRS≤2) at 6-months follow-up were endpoints of the study. Univariate and multivariate analyses were performed.

After excluding cases lost to follow-up (n=71; 15.6%), 6-months mRS data were available in 383 aSAH individuals with poor outcome at discharge. 176 patients (46%) presented with favorable outcome at 6 months and 113 individuals (29.5%) gained functional independency. In the final step of the backward conditional multivariate regression analysis, older age (>65 years, aOR=4.21, p<0.0001), 3rd ventricle ratio (>0.072, aOR=2.18, p=0.021), World Federation of Neurosurgical Societies (WFNS) grade =4-5 at admission (aOR=2.17, p=0.013), need for decompressive craniectomy (aOR=2.97, p=0.001), and mRS=5 at discharge (aOR=16.61, p<0.0001) were independently associated with a risk of unfavorable 6-months outcome. Furthermore, older age (>65 years, aOR=3.62, p=0.002), higher Hijdra sum score (>17, aOR=3.05, p=0.002), decompressive craniectomy (aOR=5.54, p<0.0001), cerebral infarcts (aOR=2.15, p=0.014) and mRS=5 at discharge (aOR=10.26, p<0.0001) were significant predictors of persistent functional dependency 6 months after aSAH.

About half of aSAH survivors in poor neurological condition at discharge reach favorable functional outcome at 6 months, with over a quarter of patients improving to functional independency. Baseline characteristics, certain adverse events and neurological condition at discharge predestinate the chances for neurological improvement in the further course.