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Systemic Severity and Organ Dysfunction in Subarachnoid Hemorrhage: A Large Retrospective Multicenter Cohort Study

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Abstract

Background and Purpose

Acute physiologic derangements and multiple organ dysfunction are common after subarachnoid hemorrhage. We aimed to evaluate the simplified acute physiology score 3 (SAPS-3) and the sequential organ failure assessment (SOFA) scores for the prediction of in-hospital mortality in a large multicenter cohort of SAH patients.

Methods

This was a retrospective analysis of prospectively collected data from 45 ICUs in Brazil, during 2014 and 2015. Patients admitted with non-traumatic subarachnoid hemorrhage (SAH) were included. Clinical and outcome data were retrieved from an electronic ICU quality registry. SAPS-3 and SOFA scores, without the neurological components (i.e., nSAPS-3 and nSOFA, respectively) were recorded, as well as the World Federation of Neurological Surgeons (WFNS) scale. We used multilevel logistic regression analysis to identify factors associated with in-hospital mortality. We evaluated performance using the area under the receiver operating characteristic curve (AUROC), as well as calibration belts and precision–recall plots.

Results

The study included 997 patients, from which 426 (43%) had poor clinical grade (WFNS 4 or 5) and in-hospital mortality was 34%. Median nSAPS-3 and nSOFA score at admission were 46 (IQR: 38–55) and 2 (0–5), respectively. Non-survivors were older, had higher nSAPS-3 and nSOFA, and more often poor grade. After adjustment for age, poor grade and withdrawal of life sustaining therapies, multivariable analysis identified nSAPS-3 and nSOFA score as independent clinical predictors of in-hospital mortality. The AUROC curve that included nSAPS-3 and nSOFA scores significantly improved the already good discrimination and calibration of age and WFNS to predict in-hospital mortality (AUROC: 0.89 for the full final model vs. 0.85 for age and WFNS; P < 0.0001).

Conclusions

nSAPS-3 and nSOFA scores were independently associated with in-hospital mortality after SAH. The addition of these scores improved early prediction of hospital mortality in our cohort and should be integrated to other specific prognostic indices in the early assessment of SAH.

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Funding

The present study was funded by institutional departmental funds (IDOR).

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Authors and Affiliations

  1. Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil

    Pedro Kurtz, Cassia Righy, Bruno Gonçalves & Ricardo Turon

  2. D ́Or Institute for Research and Education, Rio de Janeiro, Brazil

    Pedro Kurtz, Fernando A. Bozza, Marcio Soares & Jorge I. F. Salluh

  3. Dpt of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium

    Fabio Silvio Taccone

  4. National Institute of Infection, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

    Fernando A. Bozza

  5. Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil

    Leonardo S. L. Bastos

  6. Hospital Agenor Paiva, Salvador, Brazil

    Maristela Medeiros Machado

  7. Hospital Santa Luzia, Brasilia, Brazil

    Marcelo Maia

  8. Hospital São Francisco, Ribeirão Preto, Brazil

    Marcus A. Ferez

  9. Hospital Nove de Julho, São Paulo, Brazil

    Carlos Nassif

  10. Postgraduate Program, Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Jorge I. F. Salluh

  11. Hospital Copa Star, Rio de Janeiro, Brazil

    Pedro Kurtz

Authors
  1. Pedro Kurtz
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  2. Fabio Silvio Taccone
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  3. Fernando A. Bozza
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  4. Leonardo S. L. Bastos
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  5. Cassia Righy
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  6. Bruno Gonçalves
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  8. Maristela Medeiros Machado
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  9. Marcelo Maia
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  13. Jorge I. F. Salluh
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Contributions

PK conceptualization, data curation, formal analysis, supervision, validation, visualization, roles/writing – original draft, writing – review & editing. FST conceptualization, roles/writing – original draft, writing – review & editing. FAB conceptualization, data curation investigation, methodology, project administration, resources supervision, validation, roles/writing – original draft, writing – review & editing. LSLB data curation, formal analysis methodology, software. CR, BG, RT, MMM, MM, MAF, CN data curation, investigation, writing – review & editing. MS, JIFS conceptualization, data curation, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, roles/writing – original draft, writing – review & editing.

Corresponding author

Correspondence to Pedro Kurtz.

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Conflict of interest

Dr. Taccone reports other from BD, other from Zoll, other from Nihon Khoden, other from Neuroptics, all outside the submitted work. JIFS and MS are shareholders of Epimed Solutions®, outside of the submitted work. JIFS and MS are partially supported by research grants from National and State funding agencies (CNPq and FAPERJ).

Ethical Approval

The local ethics committee at the D’Or Institute for Research and Education (Approval Number 334.835) and Brazilian National Ethics Committee (CAAE 19687113.8.1001.5249) approved the study and waived need for informed consent.

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Kurtz, P., Taccone, F.S., Bozza, F.A. et al. Systemic Severity and Organ Dysfunction in Subarachnoid Hemorrhage: A Large Retrospective Multicenter Cohort Study. Neurocrit Care 35, 56–61 (2021). https://doi.org/10.1007/s12028-020-01139-3

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  • DOI: https://doi.org/10.1007/s12028-020-01139-3

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