Dados do Trabalho

Título

Risk factors and impact on outcome of delayed cerebral ischemia after aneurysmal subaracnoid haemorrhage: a multicenter observational study

Objetivo

Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) is one of the main determinants of poor outcome in patients who survive the initial bleeding. We aimed to identify risk factors for cerebral infarction associated with DCI and its impact on outcomes.

Métodos

Data were collected prospectively between 2016 and 2022 in three high SAH volume centres in Brazil. Demographic, clinical, and radiological data were collected. Mixed logistic regression models were used to investigate the association between risk factors and the development of cerebral infarction due to DCI.

Resultados

1,198 patients were included. The median age was 55 (46- 63) years, 72% were female, and 25% had poor clinical grade on admission (World Federation of Neurological Surgeons – WFNS – 4 or 5). 297 (25%) patients developed cerebral infarction due to DCI. In-Hospital mortality was 22%, and 50% had poor functional outcomes at hospital discharge (modified Rankin 4 to 6). Vasospasm was more frequent in patients with cerebral infarction (29% x 50%, p-value < 0,001). In multivariable mixed regression, premorbid arterial hypertension (Odds ratio [OR] 1.38, 95%CI 1.02-1.85), poor clinical grade (OR 1.72, 95%CI 1.24-2.38), and modified Fisher (mFisher) 3 or 4 (OR 1.67, 95%CI 1.21-2.29) were associated with cerebral infarction. Patients with DCI associated infarction were 3 times more likely to have an unfavourable outcome at hospital discharge (OR 3,7, IC 2,23-4,51).

Conclusão

Hypertension and measures of clinical and radiological severity were the main risk factors for cerebral infarction after SAH in this large cohort from a middle-income country.