Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage: Rebleeding Aneurysmal Subarachnoid Hemorrhage Study.

Autor:	van Donkelaar CE; From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), Department of Intensive Care Medicine (N.A.B.), Department of Clinical Epidemiology and Trial Coordination Center (N.J.G.M.V.), Department of Neurology (M.U., G.-J.L.), and Department of Radiology (M.U.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. c.e.van.donkelaar@umcg.nl., Bakker NA; From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), Department of Intensive Care Medicine (N.A.B.), Department of Clinical Epidemiology and Trial Coordination Center (N.J.G.M.V.), Department of Neurology (M.U., G.-J.L.), and Department of Radiology (M.U.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Veeger NJ; From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), Department of Intensive Care Medicine (N.A.B.), Department of Clinical Epidemiology and Trial Coordination Center (N.J.G.M.V.), Department of Neurology (M.U., G.-J.L.), and Department of Radiology (M.U.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Uyttenboogaart M; From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), Department of Intensive Care Medicine (N.A.B.), Department of Clinical Epidemiology and Trial Coordination Center (N.J.G.M.V.), Department of Neurology (M.U., G.-J.L.), and Department of Radiology (M.U.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Metzemaekers JD; From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), Department of Intensive Care Medicine (N.A.B.), Department of Clinical Epidemiology and Trial Coordination Center (N.J.G.M.V.), Department of Neurology (M.U., G.-J.L.), and Department of Radiology (M.U.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Luijckx GJ; From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), Department of Intensive Care Medicine (N.A.B.), Department of Clinical Epidemiology and Trial Coordination Center (N.J.G.M.V.), Department of Neurology (M.U., G.-J.L.), and Department of Radiology (M.U.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Groen RJ; From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), Department of Intensive Care Medicine (N.A.B.), Department of Clinical Epidemiology and Trial Coordination Center (N.J.G.M.V.), Department of Neurology (M.U., G.-J.L.), and Department of Radiology (M.U.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., van Dijk JM; From the Department of Neurosurgery (C.E.v.D., N.A.B., J.D.M.M., R.J.M.G., J.M.C.v.D.), Department of Intensive Care Medicine (N.A.B.), Department of Clinical Epidemiology and Trial Coordination Center (N.J.G.M.V.), Department of Neurology (M.U., G.-J.L.), and Department of Radiology (M.U.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2015 Aug; Vol. 46 (8), pp. 2100-6. Date of Electronic Publication: 2015 Jun 11.
DOI:	10.1161/STROKEAHA.115.010037
Abstrakt:	Background and Purpose: Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating type of stroke associated with high morbidity and mortality. One of the most feared complications is an early rebleeding before aneurysm repair. Predictors for such an often fatal rebleeding are largely unknown. We therefore aimed to determine predictors for an early rebleeding after aSAH in relation with time after ictus. Methods: This observational prospective cohort study included all consecutive patients admitted with aSAH between January 1998 and December 2014 (n=1337) at our University Neurovascular Center. Clinical predictors for rebleeding ≤24 hours were identified using multivariable Cox regression analyses. Kaplan-Meier analyses were applied to evaluate the time of rebleeding ≤72 hours after aSAH. Results: A modified Fisher grade of 3 to 4 was a predictor for an in-hospital rebleeding ≤24 hours after ictus (adjusted hazard ratio, 4.4; 95% confidence interval, 2.1-10.6; P<0.001). The numbers needed to treat to prevent 1 rebleeding ≤24 hours was calculated 15 (95% confidence interval, 10-25). Also, the initiation of external cerebrospinal fluid-drainage (adjusted hazard ratio, 1.9; 95% confidence interval, 1.4-2.5; P<0.001) was independently associated with a rebleeding ≤24 hours. Cumulative in-hospital rebleeding rates were 5.8% ≤24 hours, and 1.2% in the time frame 24-72 hours after ictus. Conclusions: In our opinion, timing of treatment of aSAH patients, especially those with an modified Fisher grade of 3 or 4 in a good clinical condition, should be reconsidered. These aSAH patients might be regarded a medical emergency, requiring aneurysm repair as soon as possible. In this respect, our findings should provoke the debate on timing of aneurysm repair, especially in patients considered to be at high risk for rebleeding. (© 2015 American Heart Association, Inc.)
Databáze:	MEDLINE
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