Predictors of Fatal Outcomes in Cerebral Aneurysm Rupture

Abstract

Introduction. Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and disability. Previous studies have reported a range of factors influencing in-hospital mortality after aSAH, sometimes with conflicting findings. This study aimed to identify predictors of fatal outcomes in ruptured cerebral aneurysms (CAs). Methods. The study analyzed medical records of 421 patients with ruptured CAs. Data included demographics, clinical characteristics, comorbidities, CA size and location, intracranial and infectious complications, and conditions requiring tracheostomy. Results. Conservative treatment increased the mortality risk fourfold (p < 0.001). Men treated conservatively had a 2.4-fold higher mortality risk (p = 0.039). Each additional hospital day reduced the mortality risk by a factor of 1.09 in microsurgically treated patients (p < 0.001) and by a factor of 1.15 in those receiving conservative treatment (p < 0.001). Preoperative recurrent hemorrhage was associated with a 2.3 times higher mortality risk in microsurgically treated patients (p = 0.003) and a 7.6 times higher risk in patients receiving conservative treatment (p < 0.001). In microsurgically treated patients, aneurysms in the anterior cerebral artery territory increased the mortality risk 2.3-fold (p = 0.007), while in conservatively treated patients, aneurysms in the middle cerebral artery territory increased it 3.3-fold (p = 0.044). A history of arterial hypertension was associated with a 1.83-fold lower risk of mortality among microsurgically treated patients (p = 0.042). Seizures at admission increased mortality fivefold in conservatively treated patients (p = 0.021), while headache at admission reduced mortality 2.2-fold in microsurgically (p = 0.037) and 3.26-fold in conservatively treated patients (p = 0.024). A higher WFNS grade was also a significant predictor of in-hospital mortality. Vasospasm tripled the mortality risk in microsurgically treated patients (p < 0.001). Regardless of treatment, pneumonia and conditions requiring tracheostomy increased mortality (p < 0.001). Surgery reduced mortality in patients with SAH and intraventricular hemorrhage or SAH and parenchymal hemorrhage, lowering the risk 5.15-fold (p = 0.03) and 8.7-fold (p = 0.01), respectively. Conclusions. Key mortality predictors include male sex, hospital stay duration, extent of hemorrhage, preoperative recurrent hemorrhage, CA location, seizures, absence of headache, a higher WFNS grade, vasospasm, pneumonia, and conditions requiring tracheostomy.