Journal article
Conditional Vasospasm-Free Survival Following Aneurysmal Subarachnoid Hemorrhage
Neurocritical care, Vol.37(1), pp.81-90
08/01/2022
DOI: 10.1007/s12028-022-01444-z
PMCID: PMC10949213
PMID: 35099712
Abstract
Following aneurysmal subarachnoid hemorrhage (SAH), patients are monitored closely for vasospasm in the intensive care unit. Conditional vasospasm-free survival describes the risk of future vasospasm as a function of time elapsed without vasospasm. Conditional survival has not been applied to this clinical scenario but could improve patient counseling and intensive care unit use. The objective of this study was to characterize conditional vasospasm-free survival following SAH.
This was a single institution, retrospective cohort study of patients treated for aneurysmal SAH between 1/1/2000-6/1/2020. The primary outcome was the development of vasospasm defined by the first instance of either radiographic vasospasm on computed tomography angiography, Lindegaard Index > 3.0 by transcranial doppler ultrasonography, or vasospasm-specific intraarterial therapy. Multivariable Cox regression was performed, and conditional vasospasm-free survival curves were constructed.
A total of 528 patients were treated for aneurysmal SAH and 309 (58.5%) developed vasospasm. Conditional survival curves suggest patients who survive to postbleed day 10 without vasospasm have a nearly 90% chance of being discharged without vasospasm. The median onset of vasospasm was postbleed day 6. Age more than 50 years was associated with a lower risk (hazard ratio [HR] = .76; 95% confidence interval [CI] 0.64-0.91; p < 0.001). Higher initial systolic blood pressure (HR = 1.18; 95% CI 1.046-1.350; p = .008), Hunt-Hess grades 4 or 5 (HR = 1.304; 95% CI 1.014-1.676), and modified Fisher scale score of 4 (HR = 1.808; 95% CI 1.198-2.728) were associated with higher vasospasm than the respective lower grades.
Conditional survival provides a useful framework for counseling patients and making decisions around vasospasm risk for patients with aneurysmal SAH, while risk factor-stratified plots facilitate a patient-centric, evidence-based approach to these conversations and decisions.
Details
- Title: Subtitle
- Conditional Vasospasm-Free Survival Following Aneurysmal Subarachnoid Hemorrhage
- Creators
- Patrick D Kelly - Vanderbilt University Medical CenterAaron M Yengo-Kahn - Vanderbilt University Medical CenterAlan R Tang - Vanderbilt UniversitySumeeth V Jonathan - Vanderbilt UniversityRebecca A Reynolds - Vanderbilt University Medical CenterFei Ye - Vanderbilt University Medical CenterZhiguo Zhao - Vanderbilt University Medical CenterMichael T Froehler - Vanderbilt University Medical CenterMatthew R Fusco - Vanderbilt University Medical CenterPeter J Morone - Vanderbilt University Medical CenterRohan V Chitale - Vanderbilt University Medical Center
- Resource Type
- Journal article
- Publication Details
- Neurocritical care, Vol.37(1), pp.81-90
- DOI
- 10.1007/s12028-022-01444-z
- PMID
- 35099712
- PMCID
- PMC10949213
- NLM abbreviation
- Neurocrit Care
- ISSN
- 1541-6933
- eISSN
- 1556-0961
- Grant note
- UL1 TR000445 / National Center for Advancing Translational Sciences T32CA106183 / National Cancer Institute
- Language
- English
- Date published
- 08/01/2022
- Academic Unit
- Neurosurgery
- Record Identifier
- 9984446439902771
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