INITIAL PROGNOSTIC FACTORS OF ANEURYSMAL SUBARACHNOID HEMORRHAGES

The purpose of this retrospective study is to explain, using a total o f 210 consecutive patients with aneurysmal subarachnoid hemorrhage, th e survival by several prognostic factors measured at the admission tim e. A multivariate analysis using the Cox proportional hazards model al lowed one to recognize five prognostic factors : secondary arterial hy pertension (risk ratio (RR) = 1.8; p = 0.03), the Hunt and Hess grade- 3 (RR = 3.3; p = 0.002), the Hunt and Hess grade-4 (RR = 7.3;p = 0.007 ), and the hunt and Hess grade-5 (RR = 5.8; p = 0.03), the Fisher grad e-3 (RR = 2; p = 0.01), and the Fisher grade-4 (RR = 2; p = 0.001). Th e determination of a prognostic score for each patient (using the coef ficients of selected prognostic factors) allowed one to establish 3 pr ognostic stages with survival probabilities significantly different (p = 0.00005); stage-1; survival rate after 150 days (SR) = 97 %, confid ence interval of 95 % (CI) = [0.90; 0.99], stage-2 : SR = 66 %, CI = [ 0.56; 0.74], stage-3 : SR = 34 %, CI = [0.17; 0.54]. The relative deat h risk for the stage-2 was 14 times higher than that for stage-1 (p = 0.00005), and the relative death risk for the stage-3 was 36 times hig her than that for stage-1 (p = 0.00005). The age, the essential arteri al hypertension, the sex and the angiographic classification of George have no prognostic value. The rebleeding incidence was correlated wit h prognostic stages (respectively from stage-1 to the stage-3 : 8 %, 1 4 %, 34 %). There was no incidence difference of vasospasm between the prognostic stages. The functional result was changing with the progno stic stages. This prognostic classification gives a calculated estimat ion of the survival probability. A counting-table facilitates the prog nostic score measure in clinical experience. This classification would be an easy scale to compare and to select homogeneous groups of patie nts for therapeutic tests or for timing of aneurysm surgery choices.