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Comorbidities and Medical Complications in Hospitalized Subarachnoid Hemorrhage Patients

Published online by Cambridge University Press:  19 July 2021

Solon Schur ,
Dimitra Panagiotoglou ,
Salvatore Di Maio  and
David Buckeridge
Solon Schur*
Affiliation:
Department of Neurosurgery, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Dimitra Panagiotoglou
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Salvatore Di Maio
Affiliation:
Division of Neurosurgery, Jewish General Hospital, Montreal, Quebec, Canada
David Buckeridge
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
*
Correspondence to: Solon Schur, Department of Neurosurgery, McGill University, 3801 University Street #109, Montreal, Quebec H3A 2B4, Canada. Email: solon.schur@mail.mcgill.ca
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Abstract:

Background:

Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating condition with a case fatality of 36% at 30 days. Risk factors for mortality in SAH patients include patient demographics and the severity of the neurological injury. Pre-existing conditions and non-neurological medical complications occurring during the index hospitalization are also risk factors for mortality in SAH. The magnitude of the effect on mortality of pre-existing conditions and medical complications, however, is less well understood. In this study, we aim to determine the effect of pre-existing conditions and medical complications on SAH mortality.

Methods:

For a 25% random sample of the Greater Montreal Region, we used discharge abstracts, physician billings, and death certificate records, to identify adult patients with a new diagnosis of non-traumatic SAH who underwent cerebral angiography or surgical clipping of an aneurysm between 1997 and 2014.

Results:

The one-year mortality rate was 14.76% (94/637). Having ≥3 pre-existing conditions was associated with increased one-year mortality OR 3.74, 95% CI [1.25, 9.57]. Having 2, or ≥3 medical complications was associated with increased one-year mortality OR, 2.42 [95% CI 1.25–4.69] and OR, 2.69 [95% CI 1.43–5.07], respectively. Sepsis, respiratory failure, and cardiac arrhythmias were associated with increased one-year mortality. Having 1, 2, or ≥3 pre-existing conditions was associated with increased odds of having medical complications in hospital.

Conclusions:

Pre-existing conditions and in-hospital non-neurological medical complications are associated with increased one-year mortality in SAH. Pre-existing conditions are associated with increased medical complications.

Résumé :

RÉSUMÉ :

Comorbidités et complications médicales dans le cas de patients hospitalisés à la suite d’une hémorragie sous-arachnoïdienne.

Contexte :

Les hémorragies sous-arachnoïdiennes (HSA) en cas de rupture d’anévrisme continuent à représenter une condition médicale accablante avec un taux de mortalité de 36 % au bout du trentième jour. Les facteurs de risque de mortalité chez les patients atteints de HSA en cas de rupture d’anévrisme comprennent leurs caractéristiques démographiques ainsi que la gravité des lésions neurologiques survenues. Qui plus est, des conditions préexistantes et des complications médicales non neurologiques survenant au cours de l’hospitalisation initiale sont également des facteurs de risque chez ces patients. Cela dit, l’ampleur des effets des conditions préexistantes et des complications médicales sur leur taux de mortalité demeure toutefois moins bien comprise. Notre but dans cette étude est ainsi de déterminer la nature de ces effets.

Méthodes :

C’est à partir d’un échantillon aléatoire de 25 % de la région du Grand Montréal et à l’aide de registres de congés, de factures de médecins et de certificats de décès que nous avons pu identifier des patients adultes chez qui un nouveau diagnostic non-traumatique de HSA en cas de rupture d’anévrisme avait été posé entre 1997 et 2014 et qui avaient bénéficié d’une angiographie cérébrale ou d’un clippage chirurgical.

Résultats :

Le taux de mortalité de ces patients s’est élevé à 14,76 % (94/637) au bout d’un an. Le fait d’avoir 3 conditions préexistantes ou plus a été associé à un taux de mortalité plus élevé (RC 3,74 ; IC 95 % [1,25 ; 9,57]. De plus, le fait d’avoir 2 ou 3 complications médicales ou plus a aussi été associé à un taux de mortalité plus élevé (respectivement RC 2,42 [IC 95 % ; 1,25 – 4,69] et RC 2,69 [IC 95 % ; 1,43 – 5,07]). Tant le sepsis, l’insuffisance respiratoire que les arythmies cardiaques ont été associées à une augmentation de la mortalité au bout d’un an. Finalement, le fait d’avoir 1, 2 ou 3 conditions préexistantes ou plus a été associé à une probabilité accrue d’avoir des complications médicales à l’hôpital.

Conclusion :

En somme, les conditions préexistantes et les complications médicales non neurologiques au moment d’une hospitalisation sont associées à une augmentation de la mortalité au bout d’un an dans des cas de HSA attribuables à une rupture d’anévrisme tandis que les conditions préexistantes sont associées à une augmentation des complications médicales.

Keywords

Subarachnoid hemorrhagePre-existing conditionsMedical complicationsMortalityAngiographyAneurysm clipping
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 49 , Issue 4 , July 2022 , pp. 569 - 578
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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