Case-Fatality and Functional Outcome after Subarachnoid Hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT)

• Published in: Journal of stroke and cerebrovascular diseases Vol. 31; no. 1; p. 106201
• Main Authors: Rehman, Sabah, Phan, Hoang T., Reeves, Mathew J., Thrift, Amanda G., Cadilhac, Dominique A., Sturm, Jonathan, Breslin, Monique, Callisaya, Michele L., Vemmos, Konstantinos, Parmar, Priya, Krishnamurthi, Rita V., Barker-Collo, Suzanne, Feigin, Valery, Chausson, Nicolas, Olindo, Stephane, Cabral, Norberto L., Carolei, Antonio, Marini, Carmine, Degan, Diana, Sacco, Simona, Correia, Manuel, Appelros, Peter, Kõrv, Janika, Vibo, Riina, Minelli, Cesar, Sposato, Luciano, Pandian, Jeyaraj Durai, Kaur, Paramdeep, Azarpazhooh, M. Reza, Morovatdar, Negar, Gall, Seana
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2022
• Subjects: Aged; Aged, 80 and over; case-fatality; Cerebrovascular Disorders - therapy; Female; functional outcome; Humans; Incidence; long-term outcome; Male; Middle Aged; Outcome Assessment, Health Care; Risk Factors; short-term outcome; Stroke - diagnosis; Stroke - epidemiology; Stroke - therapy; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - therapy; Treatment Outcome; long-term outcome; functional outcome; Subarachnoid hemorrhage; short-term outcome; case-fatality
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106201

There are few large population-based studies of outcomes after subarachnoid hemorrhage (SAH) than other stroke types. We pooled data from 13 population-based stroke incidence studies (10 studies from the INternational STRroke oUtComes sTudy (INSTRUCT) and 3 new studies; N=657). Primary outcomes were case-fatality and functional outcome (modified Rankin scale score 3-5 [poor] vs. 0-2 [good]). Harmonized patient-level factors included age, sex, health behaviours (e.g. current smoking at baseline), comorbidities (e.g.history of hypertension), baseline stroke severity (e.g. NIHSS >7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints. Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year. Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.