Background: The management of patients with poor-grade aneurysmal
subarachnoid hemorrhage (aSAH) is burdened by an unfavorable prognosis
even with aggressive treatment. The aim of the present study is to investigate
the risk factors affecting 30-day mortality in poor-grade aSAH patients.
Methods: We performed a retrospective analysis of a prospectively collected
database of poor-grade aSAH patients (World Federation of Neurosurgical
Societies, WFNS, grades IV and V) treated at our institution from December 2010
to December 2020. For all variables, percentages of frequency distributions
were analyzed. Contingency tables (Chi-squared test) were used to assess the
association between categorical variables and outcomes in the univariable
analysis. Multivariable analysis was performed by using the multiple logistic
regression method to estimate the odds ratio (OR) for 30-day mortality.
Results: A total of 149 patients were included of which 32% had WFNS grade
4 and 68% had WFNS grade 5. The overall 1-month mortality rate was 21%. On
univariable analysis, five variables were found to be associated with the likelihood
of death, including intraventricular hemorrhage (IVH ≥ 50 mL, p = 0.005),
the total amount of intraventricular and intraparenchymal hemorrhage
(IVH + ICH ≥ 90 mL, p = 0.019), the IVH Ratio (IVH Ratio ≥ 40%, p = 0.003),
posterior circulation aneurysms (p = 0.019), presence of spot sign on initial CT
scan angiography (p = 0.015).
Nonetheless, when the multivariable analysis was performed, only IVH Ratio
(p = 0.005; OR 3.97), posterior circulation aneurysms (p = 0.008; OR 4.05) and
spot sign (p = 0.022; OR 6.87) turned out to be independent predictors of 30-
day mortality.
Conclusion: The risk of mortality in poor-grade aSAH remains considerable
despite maximal treatment. Notwithstanding the limitations of a retrospective
study, our report highlights some neuroradiological features that in the
emergency setting, combined with leading clinical and anamnestic parameters,
may support the multidisciplinary team in the difficult decision-making process and communication with family members from the earliest stages of poor-grade aSAH. Further prospective studies are warranted
