Risk Factor For Volume Of Hemorrhage In ASAH

Objective: Aneurysmal subarachnoid hemorrhage(aSAH)is a medical emergency with a high mortality and morbidity.There is a marked association of the ensuing neurological functional deficits following aSAH with the volume of hemorrhage.The volume of intracranial hemorrhage in aSAH is usually quantified by the revised Fisher grades.In aSAH,the volume of hemorrhage is closely associated with the development of functional deficits after aSAH.As the volume of intracranial hemorrhage is associated with significant morbidity and mortality following aSAH,it is important to determine the risk factors that may be responsible for determining the volume of SAH.Methods: A total of 155 patients who suffered from aSAH were evaluated for risk factors that led to an increased volume of intracranial hemorrhage.These included various demographic factors,the medical history,the preadmission blood pressure,and the aneurysm characteristics.We examined the individual patient notes for the following parameters:1 The predisposing risk factors such as gender,age,hypertension,smoking,and diabetes mellitus;2 preadmission conditions including systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure;3 characteristics of ruptured aneurysms such as architecture,size,site(e.g.,internal carotid artery [ICA],anterior communicating artery [ACOA],middle cerebral artery [MCA],posterior cerebral artery [PCA],anterior cerebral artery [ACA],basilar artery [BA],posterior interior cerebellar artery[PICA],superior cerebellar artery [SCA],vertebral artery [VA]),number of aneurysms,maximum lumen size of the aneurysms,aneurysmal neck length,and ratio of maximum lumen size to neck length.we chose gender,age,hypertension,diabetes mellitus,smoking,preadmission SBP,DBP,pulsepressure,and aneurysm characteristics(site,size,number,maximum lumen size,neck length,and ratio of maximum lumen size to neck length)as independent variables.We used the stratified revised Fisher grades as dependent variables.Statistical analysis was performed using SAS 9.2(SAS Institute,Cary,NC,USA).Results: Univariable analysis of the risk factors responsible for the volume of hemorrhage:1.The number of aneurysms was significantly related to poor revised Fisher grades(grade 3 or 4;P=0.016).The presence of multiple aneurysms(2–4)was a significant risk factor responsible for a poor modified Fisher grade(odds ratio [OR]= 4.0,P=0.004).2.Significantly higher risk of intracranial hemorrhage was also observed for aneurysms located on the the internal carotid artery(ICA),anterior communicating artery(ACOA),or middle cerebral artery(MCA)when compared with other sites(P < 0.001).Bleeding in ACOA was significantly associated with a poor Fisher's grade(OR=4.3,P =0.025).3.the preadmission diastolic blood pressure(DBP)alone was significantly associated with a poor Fisher grade(P=0.024).Multivariable analysis of the risk factors responsible for the volume of hemorrhage:1 we found that bleeding of the ACOA was significantly associated with a poor Fisher grade(odds ratio [OR] =4.3,P=0.025).Of note,bleeding in the ICA was inversely associated with Fisher grades 0–2 in aSAH(OR=0.6,P<0.001).2 We identified that the presence of multiple aneurysms(2-4)was a significant risk factor of a poor Fisher grade(OR=4.0,P=0.004).An MCA artery aneurysm,on the contrary,had no statistical significance in increasing the likelihood of a poor Fisher grade(OR=4.1).3 Although a high preadmission DBP was significantly associated with a poor Fisher grade(P=0.047),it was not a clinically relevant risk factor(OR=1.0).Conclusion: Preadmission DBP,multiple aneurysms,and aneurysms of the ACOA are associated with markedly increased volume of hemorrhage as evaluated by the revised Fisher grades.Thus,patients harboring anintracranial aneurysm having the above mentioned features should seek an early intervention in order to prevent the occurrence of aSAH.