A Model for Prediction of In-Hospital Mortality in Patients with Subarachnoid Hemorrhage

• Published in: Neurocritical care 2021-04, Vol.34 (2), p.508-518
• Main Authors: Mourelo-Fariña, Mónica, Pértega, Sonia, Galeiras, Rita
• Format: Article
• Language: English
• Subjects: Coma; Critical Care Medicine; Hemorrhage; Hospitals; Intensive; Internal Medicine; Magnetic resonance imaging; Medical prognosis; Medicine; Medicine & Public Health; Mortality; Neurology; Neurosurgery; Original Work; Patients; Regression analysis; Variables
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-020-01041-y

Background Despite being a rare cause of stroke, spontaneous subarachnoid hemorrhage (SAH) is associated with high mortality rates. The prediction models that are currently being used on SAH patients are heterogeneous, and few address premature mortality. The aim of this study was to develop a mortality risk stratification score for SAH. Methods A retrospective study was carried out with 536 patients diagnosed with SAH who had been admitted to the intensive care unit (ICU) at the University Hospital Complex of A Coruña (Spain) between 2003 and 2013. A multivariate logistic regression model was developed to predict the likelihood of in-hospital mortality, adjusting it exclusively for variables present on admission. A predictive equation of in-hospital mortality was then computed based on the model’s coefficients, along with a points-based risk-scoring system. Its discrimination ability was also tested based on the area under the receiver operating characteristics curve and compared with previously developed scores. Results The mean age of the patients included in this study was 56.9 ± 14.1 years. Most of these patients (73.9%) had been diagnosed with aneurysmal SAH. Their median length of stay was 7 days in the ICU and 20 days in the general hospital ward, with an overall in-hospital mortality rate of 28.5%. The developed scales included the following admission variables independently associated with in-hospital mortality: coma at onset [odds ratio (OR) = 1.87; p  = 0.028], Fisher scale score of 3–4 (OR = 2.27; p  = 0.032), Acute Physiology and Chronic Health Evaluation II (APACHE II) score within the first 24 h (OR = 1.10; p