Long-term outcome 12-15 years after aneurysmal subarachnoid haemorrhage: a prospecticve cohort study

Abstract

ABSTRACT Degree Project thesis, Programme in Medicine Title: Long-term outcome 12-15 years after aneurysmal subarachnoid haemorrhage: a prospective cohort study Author, Year: Erika Svanborg, 2015 Institute, City, Country: Department of Anaesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Sweden. Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a severe disease with poor outcome. Few studies on long-term outcome exist. Therefore we initiated this outcome study, 12-15 years post-aSAH on a previously validated patient-cohort at admission and at 1-year. Aim: To investigate long-term outcomes using the Glasgow Outcome Scale (GOS). We hypothesized to find 1) functional improvement > 1-year post-ictus, 2) increased long-term mortality in aSAH patients vs. matched controls, and 3) predictors of long-term favourable outcome (GOS 4-5). Methods: We prospectively investigated data of patients admitted to the Sahlgrenska University Hospital (SU), 2000-2003. GOS, 12-15 years post-aSAH was validated by structured-telephone interviews and compared to previous GOS at 1-year follow-up. Mortality was analysed by Kaplan-Meier survival curves vs. age-, gender-, calendar year - and area-matched controls. Uni- and multivariable logistic regression analyses were applied to determine independent predictors of long-term favourable outcome. Results: 158 aSAH-patients of 212 study candidates were included, with women 72.2% and mean age 55-years (SD 10.7). In a complete follow-up at 12-15 years post-aSAH, the 103 survivors (65.2%) were categorized: good recovery (39.9%, n=63), moderate disability (15.2%, n=24) and severe disability (10.1%, n=16). 55 had died at median 3.95 years (0.01- 13.7). In the patient cohort 23.6% (n=30) improved GOS. There was a significant deterioration when dichotomized outcomes in unfavourable and favourable (p=0.0002). Age (p>0.022) and Hunt and Hess (p<0.0008) correlated to worse GOS at 12-15 years, but not gender, (p=0.69). aSAH-patients had 3.5 times increased mortality 12-15 years post-ictus vs. matched controls (p<0.0001). Patients with favourable outcome at 1-year (67.3%, n=101) had the same survival probability as controls (p=0.27). The highest prognostic indicators of longterm favourable outcome were high GOS and low age at 1-year (AUCROC, 0.79). Conclusions: Individual functional improvement occurred >1-year post-ictus. Patients with favourable outcome at 1-year had the same long-term life expectancy as the general population. High age and severe clinical status are risk factors for poor outcome. The best indicators of long-term favourable prognosis were GOS and age at 1-year follow-up.