RT Journal Article
SR Electronic
T1 Hemorrhage Volume Drives Early Brain Injury and Outcome in Poor-Grade Aneurysmal SAH
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 393
OP 399
DO 10.3174/ajnr.A8135
VO 45
IS 4
A1 Panni, Pietro
A1 Simionato, Franco
A1 Cao, Roberta
A1 Pedicelli, Alessandro
A1 Marchese, Enrico
A1 Caricato, Anselmo
A1 Alexandre, Andrea
A1 Feletti, Alberto
A1 Testa, Mattia
A1 Zanatta, Paolo
A1 Gitti, Nicola
A1 Piva, Simone
A1 Mardighian, Dikran
A1 Semeraro, Vittorio
A1 Nardin, Giordano
A1 Lozupone, Emilio
A1 Paiano, Giafranco
A1 Picetti, Edoardo
A1 Montanaro, Vito
A1 Petranca, Massimo
A1 Bortolotti, Carlo
A1 Scibilia, Antonino
A1 Cirillo, Luigi
A1 Aspide, Raffaele
A1 Lanterna, Andrea Luigi
A1 Ambrosi, Alessandro
A1 Mortini, Pietro
A1 Azzolini, Maria Luisa
A1 Calvi, Maria Rosa
A1 Falini, Andrea
A1 on behalf of the POGASH Investigators
YR 2024
UL http://www.ajnr.org/content/45/4/393.abstract
AB BACKGROUND AND PURPOSE: Early brain injury is a major determinant of clinical outcome in poor-grade (World Federation of Neurosurgical Societies [WFNS] IV–V) aneurysmal SAH and is radiologically defined by global cerebral edema. Little is known, though, about the effect of global intracranial hemorrhage volume on early brain injury development and clinical outcome.MATERIALS AND METHODS: Data from the multicentric prospective Poor-Grade Aneurysmal Subarachnoid Hemorrhage (POGASH) Registry of consecutive patients with poor-grade aneurysmal SAH admitted from January 1, 2015, to August 31, 2022, was retrospectively evaluated. Poor grade was defined according to the worst-pretreatment WFNS grade. Global intracranial hemorrhage volume as well as the volumes of intracerebral hemorrhage, intraventricular hemorrhage, and SAH were calculated by means of analytic software in a semiautomated setting. Outcomes included severe global cerebral edema (defined by Subarachnoid Hemorrhage Early Brain Edema Score grades 3–4), in-hospital mortality (mRS 6), and functional independence (mRS 0–2) at follow-up.RESULTS: Among 400 patients (median global intracranial hemorrhage volume of 91 mL; interquartile range, 59–128), severe global cerebral edema was detected in 218/400 (54.5%) patients. One hundred twenty-three (30.8%) patients died during the acute phase of hospitalization. One hundred fifty-five (38.8%) patients achieved mRS 0–2 at a median of 13 (interquartile range, 3–26) months of follow-up. Multivariable analyses showed global intracranial hemorrhage volume as independently associated with severe global cerebral edema (adjusted OR, 1.009; 95% CI, 1.004–1.014; P < .001), mortality (adjusted OR, 1.006; 95% CI, 1.001–1.01; P = .018) and worse clinical outcome (adjusted OR, 0.992; 95% CI, 0.98–0.996; P < .010). The effect of global intracranial hemorrhage volume on clinical-radiologic outcomes changed significantly according to different age groups (younger than 50, 50–70, older than 70 year of age). Volumes of intracerebral hemorrhage, intraventricular hemorrhage, and SAH affected the 3 predefined outcomes differently. Intracerebral hemorrhage volume independently predicted global cerebral edema and long-term outcome, intraventricular hemorrhage volume predicted mortality and long-term outcome, and SAH volume predicted long-term clinical outcome.CONCLUSIONS: Global intracranial hemorrhage volume plays a pivotal role in global cerebral edema development and emerged as an independent predictor of both mortality and long-term clinical outcome. Aging emerged as a reducing predictor in the relationship between global intracranial hemorrhage volume and global cerebral edema.aSAHaneurysmal SAHaORadjusted ORDCIdelayed cerebral ischemiaEBIearly brain injuryEVDexternal ventricular drainGCEglobal cerebral edemaGHVglobal intracranial hemorrhage volumeICHintracerebral hemorrhageICPintracranial pressureIQRinterquartile rangeIVHintraventricular hemorrhageLOCloss of consciousnessPOGASHPoor-Grade Aneurysmal Subarachnoid HemorrhageSEBESSubarachnoid Hemorrhage Early Brain Edema ScoreWFNSWorld Federation of Neurosurgical SocietiesVvolume