Analysis Of Prognostic Factors Of High-grade Aneurismal Subarachnoid Hemorrhage

Objective: To explore the effective prognostic factors of patients with high-grade aneurysmal subarachnoid hemorrhage(a SAH).Method: A retrospective analysis of 136 patients with high-grade(Hunt-Hess grade Ⅳ and Ⅴ on admission) a SAH in our hospital from January 2010 to October 2014 was performed. Among them, 91 were Hunt-Hess grade Ⅳ and 45 were grade Ⅴ. 70 for neurosurgical clipping, 20 for endovascular coiling and 46 for conservative treatment of ruptured aneurysms. Outcome was assessed according to the modified Rankin Scale(m RS) and stratified into favorable(m RS 0–2) versus(vs.) unfavorable(m RS 3–6) after 6 months. The relationship between the age, gender, time from onset to hospital, Hunt-Hess grade, Fisher grade, history of hypertension, previous diagnosis of hyperlipidaemia, location of aneurysm, size of aneurysm, multiple aneurysms, treatment modality, cerebrospinal fluid(CSF) drainage, delayed cerebral infarction, hydrocephalus, cerebral arteriosclerosis, pneumonia, stress ulceration, heart disease, renal insufficiency, hemoglobin < 90 g/L, hypernatremia, blood glucose >14mmol/L, hypoalbuminemia, hyperfibrinogenemia, ascension of serum transaminase and the m RS of the patients were analyzed. The data were tested using chi-square test and binary logistic regression method, and variables considered significant if P< 0.05.Results: 12 of the 136 patients were lost for the follow-up study, the rate of favorable outcome was 33.9%(42/124), the rate of unfavorable outcome was 66.1%(82/124), and the mortality was 43.5%(54/124). There were statistical differences in age, Hunt-Hess grade, treatment modality, pneumonia, hemoglobin < 90 g/L, hypernatremia, blood glucose > 14mmol/L and hyperfibrinogenemia between the group of favorable outcome and the group of unfavorable by univariate analysis(P<0.05). The results of multivariate analysis showed that the significant effects were Hunt-Hess grading onadmission(OR=5. 579,95%CI:1.557~19.738,P=0.008), neurosurgical clipping(OR=0.026,95%CI:0.004~0.173,P<0.001), endovascular coiling(OR=0.040,95%CI:0.008~0.199,P<0.001), delayed cerebral infarction(OR=4.743,95%CI:1.068~21.064,P=0.041) and hyperfibrinogenemia(OR=3.925,95%CI:1.397~11.025,P=0.009). Compared with normal level of fibrinogen, the degree of fibrinogen from 5.0 to 6.0 g/L(OR=11.573,95%CI:1.197~111.891,P=0.034) had a significant effects on the prognosis of the patients(P<0.05). Operation timing had no significant effects on the prognosis of the patients via a key-hole craniotomy for neurosurgical clipping(P>0.05).Conclusions: Hunt-Hess grading on admission, delayed cerebral infarction and hyperfibrinogenemia were the independent risk factors of patients suffering from high-grade a SAH. Patients with a degree of fibrinogen from 5.0 to 6.0 g/L are considered to achieve a poor outcome. Compare with conservative treatment, aggressive treatment such as neurosurgical clipping or endovascular coiling for ruptured aneurysms may improve the prognosis of the patients. Operation timing had no significant effects on the prognosis of the patients via a key-hole craniotomy for neurosurgical clipping.