Long-term outcomes of elderly patients with poor-grade aneurysmal subarachnoid hemorrhage.

OBJECTIVE: Long-term outcomes after surgical treatment and intensive care have not been investigated in elderly patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to analyze 12-month outcomes and prognostic factors of patients with poor-grade aSAH who were at least 70 years of age.

METHODS: We performed a single-center, retrospective study including poor-grade (World Federation of Neurological societies [WFNS] grades IV and V) aSAH patients who were at least 70 years of age, were admitted to our stroke center, and received aneurysmal treatment between April 2012 and September 2018. The clinical outcomes were evaluated at months 3 and 12. Univariate/multivariate analyses were performed to identify the independent prognostic factors of good neurological outcomes (modified Rankin Scale [mRS] score 0-3). These factors included sex, age, WFNS grade, Fisher group, delayed cerebral ischemia, aneurysm treatment, aneurysm size, aneurysm location, and blood examination data in the 14 days post SAH.

RESULTS: The proportion of patients with good outcomes (mRS score 0-3) was increased at 12 months compared to that at 3 months. No intracerebral hemorrhage (ICH) was a significant predictor of good neurological outcomes at 3 months (P=0.03). The absence of delayed cerebral ischemia and small fluctuations in the average absolute daily difference from normal sodium levels were significant predictors of good neurological outcomes at months 3 and 12 (P=0.04 and P=0.03, respectively).

CONCLUSIONS: The absence of delayed cerebral ischemia and small fluctuations in the average absolute daily difference from the normal sodium levels were independently associated with good neurological outcomes at 12 months in elderly patients. ICH did not appear to affect long-term outcomes. These findings suggest that elderly patients with severe SAH should not be excluded from receiving surgical treatment on the basis of their age alone.