Prognostic factors of aneurysmal subarachnoid hemorrhage in patients with WFNS grade I
ZHOU Jiafeng1, CHEN Yongchun1, WANG Hao1, CHEN Lifang1, LIN Boli1, XIONG Ye2, GUO Xianzhong1, YANG Yunjun1
1.Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China; 2.Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
ZHOU Jiafeng,CHEN Yongchun,WANG Hao, et al. Prognostic factors of aneurysmal subarachnoid hemorrhage in patients with WFNS grade I[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2021, 51(3): 197-202.
Abstract：Objective: To investigate the risk factors of unfavourable outcome of World Federation of Neurosurgical Societies (WFNS) grade I aneurysmal subarachnoid haemorrhage (aSAH) patients. Methods: Totally 407 patients with WFNS grade I aSAH caused by rupture of anterior communicating artery (ACoA) aneurysms, who were admitted to the First Affiliated Hospital of Wenzhou Medical University between December 2007 and January 2016, were retrospectively analyzed. Glasgow outcome scale (GOS) was used to measure clinical outcome at discharge. Unfavourable outcome was defined as a GOS score of 1~3. Univariate and multivariate logistic regression analysis were adopted to compare the patients in age, sex, treatment, medical history (hypertension, smoke), angiographic vasospasm, Fisher grade, Cerebral infarction, aneurysm morphology (aneurysm size, neck size, aspect ratio, size ratio, aneurysm angle, vessel angle, flow angle, aneurysm orientation, A1 segment types, and daughter sac). Receiver operating characteristic curve (ROC curve) was used to evaluate the predictive performance of factors related to poor prognosis. Results: Of the 407 WFNS I patients, only 30 (7.4%) had a poor prognosis. Multivariate logistic regression analysis showed that older age (OR=1.038, 95%CI=1.003-1.075, P=0.033), Fisher grade>3(OR=5.109, 95%CI=1.806-14.457, P=0.002), treatment (Coil vs. Conservative, OR=0.200, 95%CI=0.068-0.588, P=0.003) and daughter sac (OR=4.957, 95%CI=1.730-14.207, P=0.003) were independently associated with poor prognosis. In the ROC curve, the AUC in age, Fisher grade>3, treatment, daughter sac and combined diagnosis were respectively 0.691 (95%CI=0.586-0.796), 0.687 (95%CI=0.597-0.778), 0.658 (95%CI=0.543-0.773), 0.574 (95%CI=0.457-0.691) and 0.817 (95%CI=0.739-0.896). Conclusion: Older age, daughter sac, and Fisher grade >3 are the risk factors for poor prognosis of WFNS grade I aSAH patients. In addition, patients who choose embolization have better prognosis.
