Title:Association of Rebleeding and Delayed Cerebral Ischemia with Long-term
Mortality Among 1-year Survivors After Aneurysmal Subarachnoid Hemorrhage
Volume: 19
Issue: 3
Author(s): Xing Wang, Yu Zhang, Weelic Chong, Yang Hai, Peng Wang, Haidong Deng, Chao You and Fang Fang*
Affiliation:
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Keywords:
Aneurysmal subarachnoid hemorrhage, rebleeding, delayed cerebral ischemia, mortality, intracranial aneurysm, survival analysis.
Abstract:
Background and Objective: The potential impact of rebleeding and Delayed Cerebral
Ischemia (DCI) on long-term survival in patients with aneurysmal subarachnoid hemorrhage
(aSAH) remained unclear. This study aimed to investigate whether DCI and rebleeding increase the
risk of long-term all-cause mortality in patients with aSAH who survived the follow-up period of
one year.
Methods: We retrospectively collected data on patients with atraumatic aSAH who were still alive
12 months after aSAH occurrence between December 2013 and June 2019 from the electronic
health system. Patients were then classified by the occurrence of rebleeding or DCI during hospitalization.
Death records were obtained from an administrative database, the Chinese Household Registration
Administration System, until April 20, 2021. Multivariable Cox proportional hazards models
were used to compare overall survival in different groups. Sensitivity analysis was performed with
propensity-score matching (PSM).
Results: A total of 2,607 patients were alive one year after aSAH. The crude annual death rate from
any cause among patients who had rebleeding (7.2 per 100 person-years) and patients who had DCI
(3.7 per 100 person-years) during hospitalization was higher than that of patients with neither event
(2.1 per 100 person-years). Multivariate analysis showed that rebleeding is an independent risk factor
for long-term mortality (adjusted hazard ratio (aHR), 2.37; 95% confidence interval (CI), 1.47-
3.81). DCI was an independent prognostic factor of poorer overall survival (aHR, 2.09; 95% CI,
1.54-2.84).
Conclusion: Amongst patients alive one year after aSAH, rebleeding and DCI during hospitalization
were independently associated with higher rates of long-term mortality.
