Predictive Factors for Rebleeding after Aneurysmal Subarachnoid Haemorrhage.

Donkelaar, C.E. van (Karlijn) (2015) Predictive Factors for Rebleeding after Aneurysmal Subarachnoid Haemorrhage. thesis, Medicine.

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Abstract

Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating type of stroke associated with high morbidity and mortality. One of the most feared complications before aneurysm repair is early rebleeding of the aneurysm. Predictors for such an often fatal rebleeding are largely unknown. Therefore it was the aim of this study to determine predictors for an early rebleeding after aSAH in relation with time after ictus. This observational cohort study included all consecutive patients admitted with a saccular aSAH between January 1998 and December 2014 (n=1236) at our university neurovascular centre. Clinical predictors for rebleeding ≤24h were identified using multivariable Cox regression analyses. Kaplan-Meier analyses were applied to evaluate the time of rebleeding up to 72h after aSAH. After analyses, a modified Fisher (mFisher) grade of 3 or 4 was revealed as a predictor for an in-hospital rebleeding ≤24h after ictus (aHR 4.7 (95%CI 2.1-10.6) p<0.001). The number of patients with mFisher 3-4 needed to treat on emergency base to prevent one rebleeding was calculated 15 (95%CI 10-32). Also, the initiation of external cerebrospinal fluid-drainage (aHR 1.9, 95%CI 1.4-2.5, p<0.001) was independently associated with a rebleeding ≤24h. Cumulative in-hospital rebleeding rates were 5.8% ≤24h, and 7% <72h after ictus. In view of these results, timing of treatment of aSAH patients, especially those with an mFisher grade of 3 or 4 in a good clinical condition, should be reconsidered. These patients might be regarded a medical emergency, requiring aneurysm repair as soon as possible to prevent rebleeding. In this respect, these findings should provoke the debate on timing of aneurysm repair, especially in patients considered to be at high risk for rebleeding.

Item Type:	Thesis (Thesis)
Supervisor name:	Dijk, J. Marc C. Van MD PhD and Bakker, Nicolaas A. MD PhD
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:45
Last Modified:	25 Jun 2020 10:45
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/674

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