Risk Factors In Predicting Spontaneous Intracranial Aneurysm Rebleeding During Hospitalization

Background: Aneurysm rebleeding has historically been an important cause ofmortality after subarachnoid hemorrhage (SAH). Although few risk factors have beenidentified in association with rebleeding, from which there is still no clear reliableguidance about treatment.Objective: To investigate risk factors for spontaneous aneurysm rebleeding duringhospitalization and to reach conclusions if any, of clinical signs for predictingrebleeding in the modern era of aneurysm care.Methods: A Chinese case-control study was conducted.575aSAH patients wereadmitted from January,2006to September,2011, of which66were enrolled andreviewed in this study:22rebleeding, and44non-rebleeding. Aneurysm rebleedingwas documented and multiple logistic regression was used to identify predictors forrebleeding，such as gender, age of the patients, size, location of the aneurysms, CTfindings, Hunt-Hess grade, random elevated blood pressure, acute hydrocephalus,atherosclerosis, seizure as well.Results:39(6.78%) of the575patients suffered rebleeding, and66cases which metthe criterion were enrolled in this study. There were no significant differencesbetween aneurysm rebleeding and the following factors, such as gender, age,aneurysm location, number, cerebral vasospasm, atherosclerosis, intra-ventriculardrainage.(P>0.05).Large aneurysm(odds ratio [OR],0.168;95%confidence interval [CI],0.040-0.713) and high random elevated blood pressure (odds ratio [OR],0.222;95%confidence interval [CI],0.057-0.869) were independent predictors for rebleeding;Hunt-Hess grade on admission was a risk factor for rebleeding (p<0.01),and itreflected the CT findings. Ruptured aneurysm bisymptom and trisymptom couldaccurately predict rebleeding with high sensitivity (81.8%，100%) and high specificity(76.4%，72.1%).Conclusions: Large aneurysm, high random elevated blood pressure and poorHunt-Hess grade on admission are baseline predictors for aneurysm rebleeding duringhospitalization; Ruptured aneurysm bisymptom and trisymptom could well predictspontaneous aneurysm rebleeding, we recommend early vigorous surgicalintervention for patients with ruptured aneurysm bisymptom or trisymptom.