Aneurysmal subarachnoid hemorrage: multivariate analysis for functional otucome and mortality at a single institution from 2004 to 2015

Objective: The aim of our study is to analyze which factors are mostly involved in mortality rates and functional outcome in patients who suffered of aneurysmal SubArachnoid Hemorrhage (aSAH) between January 1, 2005, and December 31, 2014 admitted and treated at Mayo Clinic, in Rochester. Patients and methods: We conducted a multivariate analysis of consecutive and retrospectively collected patients suffering of aSAH in a study period from 2005 to 2014, taking into account specific factors as age, worse severity at presentation, ischemia, rebleeding and APACHE 3 (acute physiologic assessment and chronic health evaluation). Results: A total of 438 patients with a diagnosis of aSAH within 48 hours from admission were retrospectively collected. Patients demographics, aneurysms features and treatment modalities were identified. Rebleeding, worse clinical at presentation, APACHE 3, ischemia (or symptomatic vasospasm), were analyzed in a multivariate analysis for the mortality rate, whereas age, rebleeding, worse clinical at presentation, APACHE 3, ischemia were considered in a multivariate analysis for the clinical outcome at last follow-up. After controlling for comorbidities, we observed that worse clinical severity and ischemia were the major factors influencing the mortality rate (OR 5.25, CI 2.54-11.13 and OR 5.16, CI 2.35-11.46 respectively). Similarly these same factors influenced the functional outcome (worse clinical severity: OR 4.43, CI 2.30-8.61 and rebleeding: OR 3.50, CI 1.66-7.40). Less contribution was given from ischemia/ vasospasm (OR 2.01, IC 1.08-4.06). Conclusions: Management in patients with aSAH, and, as a consequence, mortality rates and functional outcome, have improved in our institution in the last decades. From our multivariate analyses we understood that rebleeding and worse clinical at presentation are the most important factors we can work on to improve good functional outcome and survival in our patients.