Patients with subarachnoid hemorrhage (SAH) admitted to hospital with a score of 5 on the World Federation of Neurological Surgeons (WFNS) were associated with poorer outcomes, according to study results published in BMC Neurology.
Study researchers used the WFNS scale to rate patients (N = 353) admitted to intensive care with nontraumatic SAH at the Erasmus hospital in Belgium between 2004 and 2018. They also assessed the associated clinical outcomes.
The study researchers rated the patients with a WFNS of 4 (32%) or 5 (68%). The SAH was caused by an aneurysm (84%), an arteriovenous malformation (2%) or of unknown origin (14%). These patients had a mean age of 57 (standard deviation ± 14) years, 42% were men, 41% had high blood pressure, 15% heart disease, and 10% diabetes.
Stratified by admission date, disease severity and use of vasopressors increased over time. Cases of previous neurological disease, cancer, and substance abuse decreased over time.
Unfavorable neurological outcomes occurred in 74% and mortality in 57% of the patients. Of all adverse neurological outcomes and deaths, 77% and 81%, respectively, were among those patients with a WFNS score of 5.
Over time, the proportion of patients with poor neurological outcomes and mortality did not vary significantly. Patients enrolled between 2008 and 2011 (hazard ratio [HR], 0.55; 95% CI 0.34-0.89) or 2016 and 2018 (HR 0.33; 95% CI 0.20-0.53) were compared to patients enrolled between 2004 and 2007, associated with a lower risk of mortality.
A reduced risk of mortality was with prophylactic nimodipine (HR 0.50; 95% CI 0.35-0.72; P = 0.001), endovascular treatment (HR 0.51; 95% CI 0.36-0.73; P = 0.001) and hydrocephalus. linked (HR, 0.60; 95% CI, 0.43-0.84; P = 0.002).
Increased mortality risk was associated with intracranial hypertension (HR 3.56; 95% CI 2.33–5.41; P = 0.001), WFNS score of 5 (HR 2.12; 95% CI 1.43–3.14 ; P = 0.001), sequential organ failure assessment score (HR, 1.10; 95% CI, 1.03-1.17; P = 0.006) and age (HR, 1.02; 95% CI, 1.00-1 , 03; P = 0.022).
Unfavorable neurological results were intracranial hypertension (HR 10.15; 95% CI 5.24-19.66; P = 0.001), a WFNS score of 5 (HR 3.23; 95% CI 1.67-6 , 25; P = 0.001). and age (HR 1.04; 95% CI 1.01-1.06; P = 0.005). Prophylactic nimodipine reduced the risk of adverse neurological outcomes (HR 0.29; 95% CI 0.11-0.77; P = 0.013).
This study may have been limited by the exclusion of many additional variables and subjectivity in deciding on specific therapies for patients. It remains unclear whether the longer-term outcomes would differ based on the WFNS score.
These data showed that patients with SAH who had a WFNS score of 5 were at increased risk of poorer clinical outcomes and mortality.
Bogossian EG, Diaferia D, Minini A, et al. Time course of outcome in patients with poor grade subarachnoid hemorrhage: a retrospective longitudinal study. BMC Neurol. 2021; 21 (1): 196. doi: 10.1186 / s12883-021-02229-1