2023 Volume 51 Issue 2 Pages 117-123
Background: Poor-grade subarachnoid hemorrhage (SAH) accounts for approximately 20% of SAH cases. Generally, patients with poor-grade SAH are considered to have a poor prognosis, and the treatment indication for such patients remains controversial. This study aimed to investigate the independent risk factors affecting clinical outcomes to improve the prognosis of patients with poorgrade SAH.
Methods: We selected 95 patients with poor-grade SAH were treated at our institution from January 2008 to September 2017. Poor-grade SAH was defined as having Hunt and Kosnik Grades IV and V on admission. Clinical outcomes were assessed according to the modified Rankin Scale on discharge and stratified into favorable (modified Rankin Scale [mRS] scores 0–3) and unfavorable (mRS score 4–6). Clinical data including patient characteristics on admission and during treatment course, treatment modality, aneurysm location, and radiologic features were collected. Risk factors affecting clinical outcomes were assessed using univariate and multivariate analyses. Subgroup analyses of operative cases and Grades IV and V cases were also performed.
Results: Of the 95 patients, 32 had favorable outcomes whereas 63 had unfavorable outcomes. In the multivariate analysis, conservative treatment, Hunt and Kosnik grade V on admission, and seizure were identified as significant predictors of unfavorable outcomes in patients with poor-grade SAH. In the operative cases, no significant predictors of unfavorable outcomes were identified. In the Grade IV cases, conservative treatment was identified as a significant predictor of unfavorable outcomes. In the Grade V cases, the patients with favorable outcomes had a high frequency of pupil reactivity.
Conclusion: To improve the prognosis of patients with poor-grade SAH, those with Grade IV should be treated promptly for aneurysm. Patients with grade Vshould immediately receive treatment for aneurysm when brainstem dysfunction is judged as reversible.
