TY - JOUR
T1 - Prognostic value of premorbid hypertension and neurological status in aneurysmal subarachnoid hemorrhage
T2 - Pooled analyses of individual patient data in the SAHIT repository
AU - Jaja, Blessing N R
AU - Lingsma, Hester
AU - Schweizer, Tom A.
AU - Thorpe, Kevin E.
AU - Steyerberg, Ewout W.
AU - Macdonald, R. Loch
AU - Louffat-Olivares, Ada
AU - Noble, Adam
AU - Molyneux, Andrew
AU - Quinn, Audrey
AU - Lo, Benjamin
AU - Johnston, Clay
AU - Hanggi, Daniel
AU - Hasan, David
AU - Wong, George K C
AU - Torner, James
AU - Singh, Jeff
AU - Spears, Julian
AU - Vergouwen, Mervyn D I
AU - Cusimano, Michael D.
AU - Todd, Michael
AU - Tseng, Ming
AU - Etminan, Nima
AU - Le, Peter
AU - Mayer, Stephan
AU - Schenk, Thomas
AU - Van, William
PY - 2015/3/1
Y1 - 2015/3/1
N2 - OBJECTThe literature has conflicting reports about the prognostic value of premorbid hypertension and neurological status in aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to investigate the prognostic value of premorbid hypertension and neurological status in the SAH International Trialists repository. METHODS:Patient-level meta-analyses were conducted to investigate univariate associations between premorbid hypertension (6 studies; n = 7249), admission neurological status measured on the World Federation of Neurosurgical Societies (WFNS) scale (10 studies; n = 10,869), and 3-month Glasgow Outcome Scale (GOS) score. Multivariable analyses were performed to sequentially adjust for the effects of age, CT clot burden, aneurysm location, aneurysm size, and modality of aneurysm repair. Prognostic associations were estimated across the ordered categories of the GOS using proportional odds models. Nagelkerke's R2 statistic was used to quantify the added prognostic value of hypertension and neurological status beyond those of the adjustment factors. RESULTS:Premorbid hypertension was independently associated with poor outcome, with an unadjusted pooled odds ratio (OR) of 1.73 (95% confidence interval [CI] 1.50-2.00) and an adjusted OR of 1.38 (95% CI 1.25-1.53). Patients with a premorbid history of hypertension had higher rates of cardiovascular and renal comorbidities, poorer neurological status (p ≤ 0.001), and higher odds of neurological complications including cerebral infarctions, hydrocephalus, rebleeding, and delayed ischemic neurological deficits. Worsening neurological status was strongly independently associated with poor outcome, including WFNS Grades II (OR 1.85, 95% CI 1.68-2.03), III (OR 3.85, 95% CI 3.32-4.47), IV (OR 5.58, 95% CI 4.91-6.35), and V (OR 14.18, 95% CI 12.20-16.49). Neurological status had substantial added predictive value greater than the combined value of other prognostic factors (R2 increase > 10%), while the added predictive value of hypertension was marginal (R2 increase <0.5%).CONCLUSIONS:This study confirmed the strong prognostic effect of neurological status as measured on the WFNS scale and the independent but weak prognostic effect of premorbid hypertension. The effect of premorbid hypertension could involve multifactorial mechanisms, including an increase in the severity of initial bleeding, the rate of comorbid events, and neurological complications.
AB - OBJECTThe literature has conflicting reports about the prognostic value of premorbid hypertension and neurological status in aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to investigate the prognostic value of premorbid hypertension and neurological status in the SAH International Trialists repository. METHODS:Patient-level meta-analyses were conducted to investigate univariate associations between premorbid hypertension (6 studies; n = 7249), admission neurological status measured on the World Federation of Neurosurgical Societies (WFNS) scale (10 studies; n = 10,869), and 3-month Glasgow Outcome Scale (GOS) score. Multivariable analyses were performed to sequentially adjust for the effects of age, CT clot burden, aneurysm location, aneurysm size, and modality of aneurysm repair. Prognostic associations were estimated across the ordered categories of the GOS using proportional odds models. Nagelkerke's R2 statistic was used to quantify the added prognostic value of hypertension and neurological status beyond those of the adjustment factors. RESULTS:Premorbid hypertension was independently associated with poor outcome, with an unadjusted pooled odds ratio (OR) of 1.73 (95% confidence interval [CI] 1.50-2.00) and an adjusted OR of 1.38 (95% CI 1.25-1.53). Patients with a premorbid history of hypertension had higher rates of cardiovascular and renal comorbidities, poorer neurological status (p ≤ 0.001), and higher odds of neurological complications including cerebral infarctions, hydrocephalus, rebleeding, and delayed ischemic neurological deficits. Worsening neurological status was strongly independently associated with poor outcome, including WFNS Grades II (OR 1.85, 95% CI 1.68-2.03), III (OR 3.85, 95% CI 3.32-4.47), IV (OR 5.58, 95% CI 4.91-6.35), and V (OR 14.18, 95% CI 12.20-16.49). Neurological status had substantial added predictive value greater than the combined value of other prognostic factors (R2 increase > 10%), while the added predictive value of hypertension was marginal (R2 increase <0.5%).CONCLUSIONS:This study confirmed the strong prognostic effect of neurological status as measured on the WFNS scale and the independent but weak prognostic effect of premorbid hypertension. The effect of premorbid hypertension could involve multifactorial mechanisms, including an increase in the severity of initial bleeding, the rate of comorbid events, and neurological complications.
KW - Hypertension
KW - Meta-analysis
KW - Neurological status
KW - Outcomes
KW - Prognostic factors
KW - Subarachnoid hemorrhage
KW - Vascular disorders
UR - http://www.scopus.com/inward/record.url?scp=84927974304&partnerID=8YFLogxK
U2 - 10.3171/2014.10.JNS132694
DO - 10.3171/2014.10.JNS132694
M3 - Article
C2 - 25554825
AN - SCOPUS:84927974304
SN - 0022-3085
VL - 122
SP - 644
EP - 652
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 3
ER -