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Prospective study: Long-term outcome at 12-15years after aneurysmal subarachnoid hemorrhage

Journal article
Authors Dovile Rackauskaite
E. Svanborg
E Andersson
Karin Lowhagen
L. Csajbok
Bengt Nellgård
Published in Acta Neurologica Scandinavica
Volume 138
Issue 5
Pages 400-407
ISSN 0001-6314
Publication year 2018
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Institute of Clinical Sciences
Pages 400-407
Language en
Links dx.doi.org/10.1111/ane.12980
Keywords cerebrovascular diseases, neurointensive care, rehabilitation, strokes, case-fatality rates, intracranial aneurysms, practical scale, guidelines, mortality, risk, age, metaanalysis, management, emphasis, Neurosciences & Neurology, armark je, 1988, acta neurochirurgica, v91, p12, hievink wi, 1995, neurology, v45, p871
Subject categories Neurosciences

Abstract

BackgroundPatients with aneurysmal subarachnoid hemorrhage (aSAH) have poor outcome. Studies on outcome beyond 1year post-aSAH are few, and late recovery is poorly investigated, initiating this prospective outcome study on patients 12-15years after an aSAH. We hypothesized to find; functional improvement>1year post-ictus; increased long-term mortality in aSAH patients vs matched controls, and finally to present; predictors of long-term favorable outcome (GOS 4-5). MethodsWe prospectively investigated patients, admitted 2000-2003 to the Sahlgrenska University Hospital, 1year post-ictus using Glasgow Outcome Scale (GOS). The patients were revalidated 12-15years post-aSAH by structured-telephone interviews (GOS), followed by statistical analysis. ResultsA total of 158 patients were included, (women n=114, men n=44), with a mean age of 55years at aSAH. Patients treated with surgical clipping had lower mortality. At the follow-up 12-15years post-aSAH, all 103 survivors (65.2%) were categorized as having; good recovery (39.9%), moderate disability (15.2%), or severe disability (10.1%). Within the patient cohort, 23.6% improved GOS over time. Fifty-five patients died, median at 4years post-ictus. aSAH patients had 3.5 times increased mortality 12-15years post-ictus vs matched controls (P<.0001). Patients with favorable outcome at 1year (67.3%, n=101) had similar survival probability as control patients. Prognostic indicators of long-term favorable outcome were low age and high GOS at 1-year follow-up, (AUCROC, 0.79). ConclusionsIndividual functional improvement was found >1year post-ictus. Patients with favorable outcome at 1year had similar long-term life expectancy as the general population. Indicators of long-term favorable prognosis were low age at ictus and high GOS at 1-year follow-up.

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