Charlson comorbidity index as a predictor of initial severity, clinical course, and treatment outcomes in aneurysmal subarachnoid hemorrhagе due to anterior communicating artery rupture

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition in which baseline comorbidity burden may significantly influence the clinical course and outcomes. The Charlson Comorbidity Index (CCI) is widely used to quantify chronic disease burden; however, its prognostic value in aSAH remains controversial. Anterior communicating artery (AComA) aneurysms represent the most common site of rupture, and a focused evaluation of the impact of comorbidities within this subgroup is therefore warranted. Aіm. To investigate the impact of the CCI on initial disease severity, clinical course, and treatment outcomes in patients with aSAH resulting from AComA rupture. Materіals and methods. This retrospective cohort analysis included 222 patients in the acute phase of aSAH due to AComA aneurysm rupture. Patients were stratified into four groups according to the CCI. The study methods included analysis of clinical data and statistical evaluation using descriptive statistics, multinomial logistic regression, and Pearson’s chi-square test. Results. Men were significantly more likely to have no comorbidities, whereas moderate and high comorbidity levels were more frequent among women. No statistically significant differences in CCI distribution were observed between the two decades. Higher CCI was associated with greater odds of severe clinical presentation according to the modified World Federation of Neurosurgical Societies (mWFNS) scale (p=0.021, p=0.003, and p=0.007). Patients with CCI 2 and CCI 3 had higher odds of poor neurological status according to the Hunt-Hess (HH) scale (p=0.004 and p=0.002, respectively). Higher CCI was also associated with combined hemorrhage (p=0.020, p=0.012, and p=0.007). Non-operated patients more often had moderate or high comorbidity, whereas operated patients more frequently had no or low CCI. Higher CCI was associated with increased odds of death and severe neurological deficit at discharge (p=0.009 and p=0.050, respectively). No associations were found between the CCI and length of hospital or intensive care unit stay, vasospasm, seizure incidence, rebleeding, meningitis, or pneumonia (p>0.05). Conclusіons. In patients with ruptured AComA aneurysms, a higher comorbidity burden was associated with more severe neurological status at admission, greater hemorrhage extent, and poorer outcomes. In operated patients, a lower comorbidity burden was observed more often.