Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.06.004
Brazilian Journal of Anesthesiology
Scientific Article

Risk factors for mortality after subarachnoid hemorrhage: a retrospective observational study

Fatores de risco para mortalidade após hemorragia subaracnoidea: estudo observacional retrospectivo

Matthaios Papadimitriou-Olivgeris, Anastasia Zotou, Kyriaki Koutsileou, Diamanto Aretha, Maria Boulovana, Theofanis Vrettos, Christina Sklavou, Markos Marangos, Fotini Fligou

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Abstract

Background and objectives
Subarachnoid haemorrhage is an important cause of morbidity and mortality. The aim of the study was to determine predictors of mortality among patients with subarachnoid haemorrhage hospitalized in an Intensive Care Unit.

Methods
This is a retrospective study of patients with subarachnoid haemorrhage admitted to the Intensive Care Unit of our institution during a 7 year period (2009–2015). Data were collected from the Intensive Care Unit computerized database and the patients’ chart reviews.

Results
We included in the study 107 patients with subarachnoid haemorrhage. A ruptured aneurysm was the cause of subarachnoid haemorrhage in 76 (71%) patients. The overall mortality was 40% (43 patients), and was significantly associated with septic shock, midline shift on CT scan, inter‐hospital transfer, aspiration pneumonia and hypernatraemia during the first 72 hours of Intensive Care Unit stay. Multivariate analysis of patients with subarachnoid haemorrhage following an aneurysm rupture revealed that mortality was significantly associated with septic shock and hypernatremia during the first 72 hours of Intensive Care Unit stay, while early treatment of aneurysm (clipping or endovascular coiling) within the first 72 hours was identified as a predictor of a good prognosis.

Conclusions
Transferred patients with subarachnoid haemorrhage had lower survival rates. Septic shock and hypernatraemia were important complications among critically ill patients with subarachnoid haemorrhage and were associated increased mortality.

Keywords

Intensive Care Unit; Inter‐hospital transfer; Septic shock; Carbapenemase‐producing bacteria; Hypernatraemia

Resumo

Justificativa e objetivos
A hemorragia subaracnoidea é uma causa importante de morbidade e mortalidade. O objetivo do estudo foi determinar os preditivos de mortalidade entre os pacientes com hemorragia subaracnoidea internados em uma Unidade de Terapia Intensiva.

Métodos
Estudo retrospectivo de pacientes com hemorragia subaracnoidea internados na Unidade de Terapia Intensiva de nossa instituição de 2009 a 2015. Os dados foram coletados do banco de dados eletrônico da Unidade de Terapia Intensiva e de revisões dos prontuários dos pacientes.

Resultados
Incluímos no estudo 107 pacientes com hemorragia subaracnoidea. A ruptura de aneurisma foi a causa da hemorragia subaracnoidea em 76 pacientes (71%). A mortalidade geral foi de 40% (43 pacientes) e esteve significativamente associada ao choque séptico, desvio da linha média na tomografia computadorizada, transferência inter‐hospitalar, pneumonia por aspiração e hipernatremia durante as primeiras 72 horas de internação na Unidade de Terapia Intensiva. A análise multivariada dos pacientes com hemorragia subaracnoidea pós‐ruptura de aneurisma revelou que a mortalidade esteve significativamente associada ao choque séptico e hipernatremia nas primeiras 72 horas de permanência na Unidade de Terapia Intensiva, enquanto o tratamento precoce do aneurisma (clipagem ou embolização endovascular) nas primeiras 72 horas foi identificado como preditivo de um bom prognóstico.

Conclusões
Os pacientes com hemorragia subaracnoidea transferidos apresentaram taxas menores de sobrevivência. Choque séptico e hipernatremia foram complicações importantes entre os pacientes gravemente enfermos com hemorragia subaracnoidea e foram associados ao aumento da mortalidade.

Palavras-chave

Unidade de Tratamento Intensivo; Transferência inter‐hospitalar; Choque séptico; Bactérias produtoras de carbapenemases; Hipernatremia

References

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