Risk factors for re-bleeding of aneurysmal subarachnoid hemorrhage: Meta-analysis of observational studies |
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| Institution: | 1. Department of Neurosurgery, Medical University of Bialystok, Bialystok, Poland;2. Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland;1. Department of Neurology, Medical University of Warsaw, Warsaw, Poland;2. Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland;1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease), Beijing, China;2. Department of Neurosurgery, First affiliated Hospital of Wenzhou Medical University, Wenzhou, China;3. Department of Neurosurgery, Mayo Clinic, Rochester, USA;1. Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China;2. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China |
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| Abstract: | ObjectiveThe mortality of re-bleeding following aneurysmal subarachnoid hemorrhage is high, and surviving patients often have poor clinical condition and worse outcome than patients with a single bleed. In this study, we performed an updated systematic review and meta-analysis to determine the most common risk factors for re-bleeding in this patient population, with the goal of providing neurologists, neurosurgeons, neuro-interventionalists with a simple and fast method to evaluate the re-bleeding risk for aneurysmal subarachnoid hemorrhage.MethodWe conducted a thorough meta-analysis of the risk factors associated with re-bleeding or re-rupture of intracranial aneurysms in cases published between 2000 and 2013. Pooled mean difference was calculated for the continuous variables (age), and pooled odds ratio (OR) was calculated for categorical factors. If heterogeneity was significant (p < 0.05), a random effect model was applied; otherwise, a fixed model was used. Testing for pooled effects and statistical significance for each potential risk factor were analyzed using Review Manager software.ResultsOur literature search identified 174 articles. Of these, only seven retrospective studies met the inclusion criteria. These seven studies consisted of 2470 patients, 283 of which had aneurysmal re-bleeding, resulting in a weighted average rate of re-bleeding of 11.3% with 95% confidence interval CI]: 10.1–12.6. In this population, sex (OR 1.46; 95% CI: 1.11–1.92), high systolic blood pressure SBP] (OR 2.52; 95% CI: 1.40–4.53), aneurysm size (OR 3.00; 95% CI: 2.06–4.37), clinical condition (Hunt & Hess) (OR 4.94; 95% CI: 2.29,10.68), and Fisher grade (OR 2.29; 95% CI: 1.45, 3.61) were statistically significant risk factors for re-bleeding.ConclusionSex, high SBP, high Fisher grade, aneurysm size larger than 10 mm, and poor clinical condition were independent risk factors for aneurysmal re-bleeding. The importance of early aneurysm intervention and careful consideration of patient risk factors should be emphasized to eliminate the risk of re-bleeding and poor outcome. |
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| Keywords: | Cerebral aneurysm Subarachnoid hemorrhage Re-bleeding risk factor Meta-analysis |
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