Investigating the Relationship between Demographic, Radiological and Clinical Factors and In-Hospital Mortality of Non-Traumatic Subarachnoid Hemorrhage Before and After COVID-19 Pandemic
DOI:
https://doi.org/10.31661/gmj.v14i.3866Keywords:
Subarachnoid Hemorrhage; Mortality; Covid-19, Risk Factors; Glasgow Coma Scale; Aneurysm; AngiographyAbstract
Background: Subarachnoid hemorrhage (SAH) is a life-threatening neurological condition that accounts for approximately 5% of all strokes. This study aimed to evaluate the demographic, clinical, and radiological factors associated with in-hospital mortality in patients with non-traumatic SAH and to assess potential differences before and after the COVID-19 pandemic. Materials and Methods: This retrospective analytical study was conducted on 177 patients with non-traumatic SAH admitted to Imam Hossein Hospital, Tehran, from November 2021 to December 2022. Diagnosis was confirmed by a neurologist using clinical presentation, imaging, and cerebrospinal fluid analysis. Patients were grouped based on discharge status (deceased vs. survived), and also classified into early- and late- pandemic subgroups based on their admission date. Comparative analyses and binary logistic regression were performed to identify predictors of in-hospital mortality. Results: Among 177 patients (mean age: 54.75 years), 36 (20.3%) died during hospitalization. Blood pressure, blood sugar, and level of consciousness at admission were significantly associated with mortality (P < 0.05), as were disease severity (Hunt and Hess grade) and angiography status (P < 0.001). No significant associations were found for age, sex, hospitalization duration, creatinine, platelets, hypertension, diabetes, or aneurysm characteristics (P > 0.05). Logistic regression identified lower Glasgow Coma Scale (GCS) scores (P < 0.001) and higher systolic blood pressure (P = 0.004) as independent predictors of mortality. Mortality was higher in the late-pandemic group (23.9% vs. 16.0%), though not statistically significant (P = 0.18). Conclusion: Lower GCS scores and elevated systolic blood pressure at admission were independent predictors of in-hospital mortality in patients with non-traumatic SAH. The COVID-19 pandemic period was associated with reduced use of angiography and a trend toward increased mortality, underscoring the importance of maintaining access to timely care during public health crises. [GMJ.2025;14:e3866] DOI:10.31661/gmj.v14i.3866
References
Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018 Apr 27;130(4):1080-1097.
https://doi.org/10.3171/2017.10.JNS17352
PMid:29701556
Ikawa F, Michihata N, Matsushige T, Abiko M, Ishii D, Oshita J, et al. In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases: a systematic review and meta-analysis. Neurosurg Rev. 2020 Apr; 43:655-67.
https://doi.org/10.1007/s10143-019-01096-2
PMid:30941595
King Jr JT. Epidemiology of aneurysmal subarachnoid hemorrhage. Neuroimaging Clin N Am. 1997 Nov 1;7(4):659-68.
https://doi.org/10.1016/S1052-5149(25)00481-2
PMid:9336491
Van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001 Feb 1;124(2):249-78.
https://doi.org/10.1093/brain/124.2.249
PMid:11157554
Hop JW, Rinkel GJ, Algra A, van Gijn J. Changes in functional outcome and quality of life in patients and caregivers after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2001 Dec 1;95(6):957-63.
https://doi.org/10.3171/jns.2001.95.6.0957
PMid:11765839
Broderick JP, Brott TG, Duldner JE, Tomsick T, Leach A. Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke. 1994 Jul;25(7):1342-7.
https://doi.org/10.1161/01.STR.25.7.1342
PMid:8023347
Conzen C, Becker K, Albanna W, Weiss M, Bach A, Lushina N, et al. The acute phase of experimental subarachnoid hemorrhage: intracranial pressure dynamics and their effect on cerebral blood flow and autoregulation. Transl Stroke Res. 2019 Oct; 10:566-82.
https://doi.org/10.1007/s12975-018-0674-3
PMid:30443885
Kafle P, Vignesh S, Bhandari S, Shrestha GS. Subarachnoid Hemorrhage. CB-CNDA 2024 Mar 14 (pp. 79-95). Singapore: Springer Nature Singapore.
https://doi.org/10.1007/978-981-99-8676-7_11
Kamińska J, Maciejczyk M, Ćwiklińska A, Matowicka-Karna J, Koper-Lenkiewicz OM. Pro-inflammatory and anti-inflammatory cytokines levels are significantly altered in cerebrospinal fluid of unruptured intracranial aneurysm (UIA) patients. J Inflamm Res. 2022 Jan 1:6245-61.
https://doi.org/10.2147/JIR.S380524
PMid:36386592 PMCid:PMC9664915
Lucke-Wold B, Dodd W, Motwani K, Hosaka K, Laurent D, Martinez M, et al. Investigation and modulation of interleukin-6 following subarachnoid hemorrhage: targeting inflammatory activation for cerebral vasospasm. J Neuroinflammation. 2022 Sep 16;19(1):228.
https://doi.org/10.1186/s12974-022-02592-x
PMid:36114540 PMCid:PMC9479230
Sundt TM, Kobayashi S, Fode NC, Whisnant JP. Results and complications of surgical management of 809 intracranial aneurysms in 722 cases: related and unrelated to grade of patient, type of aneurysm, and timing of surgery. J Neurosurg. 1982 Jun 1;56(6):753-65.
https://doi.org/10.3171/jns.1982.56.6.0753
PMid:6804608
Sharma J, Defoe D, Gillen J, Kuo YH, Perez J, Dalal S, et al. Putting a halt to unnecessary transfers: do patients with isolated subarachnoid hemorrhage and Glasgow Coma Scale of 13 to 15 need a trauma center?. J Trauma Acute Care Surg. 2020 Jul 1;89(1):222-5.
https://doi.org/10.1097/TA.0000000000002645
PMid:32118824
Etminan N, Chang HS, Hackenberg K, De Rooij NK, Vergouwen MD, Rinkel GJ, Algra A. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol. 2019 May 1;76(5):588-97.
https://doi.org/10.1001/jamaneurol.2019.0006
PMid:30659573 PMCid:PMC6515606
Azami R, Farshbaf-Khalili A, Mahdipour M, Firozsalar FG, Shahnazi M. Effect of Nigella sativa oil on early menopausal symptoms and serum levels of oxidative markers in menopausal women: A randomized, triple-blind clinical trial. Nurs midwifery stud. 2022 Apr 1;11(2):103-11.
Zhang J, Xue Y, Gao J, Li Y, Shi K, Diao W, Li J. Subarachnoid hemorrhage after full endoscopic transforaminal lumbar interbody fusion: a case report. Br J Neurosurg. 2023 Nov 2;37(6):1757-60.
https://doi.org/10.1080/02688697.2021.1902473
PMid:33739220
Van Lieshout JH, Bruland I, Fischer I, Cornelius JF, Kamp MA, Turowski B, Tortora A, Steiger HJ, Petridis AK. Increased mortality of patients with aneurysmatic subarachnoid hemorrhage caused by prolonged transport time to a high-volume neurosurgical unit. Am J Emerg Med. 2017 Jan 1;35(1):45-50.
https://doi.org/10.1016/j.ajem.2016.09.067
PMid:27742521
Edlow JA. Diagnosis of subarachnoid hemorrhage in the emergency department. Emerg Med Clin North AM. 2003 Feb 1;21(1):73-87.
https://doi.org/10.1016/S0733-8627(02)00081-0
PMid:12630732
Papadimitriou-Olivgeris M, Zotou A, Koutsileou K, Aretha D, Boulovana M, Vrettos T, Sklavou C, Marangos M, Fligou F. Risk factors for mortality after subarachnoid hemorrhage: a retrospective observational study. Braz J Anesthesiol. 2019 Dec 20; 69:448-54.
https://doi.org/10.1016/j.bjane.2019.06.004
PMCid:PMC9391911
Kim J, Kim JH, Lee HS, Suh SH, Lee KY. Association between longitudinal blood pressure and prognosis after treatment of cerebral aneurysm: A nationwide population-based cohort study. PLoS One. 2021 May 27;16(5):e0252042.
https://doi.org/10.1371/journal.pone.0252042
PMid:34043701 PMCid:PMC8158927
Abulhasan YB, Alabdulraheem N, Simoneau G, Angle MR, Teitelbaum J. Mortality after spontaneous subarachnoid hemorrhage: causality and validation of a prediction model. World Neurosurg. 2018 Apr 1;112:e799-811.
https://doi.org/10.1016/j.wneu.2018.01.160
PMid:29410174
Bian LH, Liu YF, Nichols LT, Wang CX, Wang YL, Liu GF, et al. Epidemiology of subarachnoid hemorrhage, patterns of management, and outcomes in China: a hospital‐based multicenter prospective study. CNS Neurosci Ther. 2012 Nov;18(11):895-902.
https://doi.org/10.1111/cns.12001
PMid:22966850 PMCid:PMC6493563
Hammer A, Steiner A, Ranaie G, Yakubov E, Erbguth F, Hammer CM, et al. Impact of comorbidities and smoking on the outcome in aneurysmal subarachnoid hemorrhage. Sci Rep. 2018 Aug 17;8(1):12335.
https://doi.org/10.1038/s41598-018-30878-9
PMid:30120370 PMCid:PMC6098072
McGurgan IJ, Clarke R, Lacey B, Kong XL, Chen Z, Chen Y, Guo Y, Bian Z, Li L, Lewington S, China Kadoorie Biobank Consortium. Blood pressure and risk of subarachnoid hemorrhage in China. Stroke. 2019 Jan;50(1):38-44.
https://doi.org/10.1161/STROKEAHA.118.022239
PMid:30580702 PMCid:PMC6314500
COVID S. Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up. J Neurol Neurosurg Psychiatry. 2022 Oct 1;93(10):1028-38.
https://doi.org/10.1136/jnnp-2022-329200
PMid:35902229
Nguyen TN, Abdalkader M, Jovin TG, Nogueira RG, Jadhav AP, Haussen DC, Hassan AE, Novakovic R, Sheth SA, Ortega-Gutierrez S, Panagos PD. Mechanical thrombectomy in the era of the COVID-19 pandemic: emergency preparedness for neuroscience teams: a guidance statement from the Society of Vascular and Interventional Neurology. Stroke. 2020 Jun;51(6):1896-901.
https://doi.org/10.1161/STROKEAHA.120.030100
PMid:32347790 PMCid:PMC7202095
Yao XY, Jiang CQ, Jia GL, Chen G. Diabetes mellitus and the risk of aneurysmal subarachnoid haemorrhage: A systematic review and meta-analysis of current evidence. J Int Med Res. 2016 Dec;44(6):1141-55.
https://doi.org/10.1177/0300060516666426
PMid:28322094 PMCid:PMC5536738
Feigin V, Parag V, Lawes CM, Rodgers A, Suh I, Woodward M, Jamrozik K, Ueshima H. Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the Asia-Pacific region: an overview of 26 cohorts involving 306 620 participants. Stroke. 2005 Jul 1;36(7):1360-5.
https://doi.org/10.1161/01.STR.0000170710.95689.41
PMid:15933249
Juvela S, Siironen J, Kuhmonen J. Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage. J. Neurosurg 2005 Jun 1;102(6):998-1003.
https://doi.org/10.3171/jns.2005.102.6.0998
PMid:16028757
Ok T, Jeon J, Heo SJ, Kim J. Effect of smoking cessation on the risk of subarachnoid hemorrhage: a nested case-control study in Korean men. Stroke. 2023 Dec;54(12):3012-20.
https://doi.org/10.1161/STROKEAHA.123.044969
PMid:37909203
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