Risk factors related to aneurysmal rebleeding

Abstract

Objective: Rebleeding from ruptured intracranial aneurysms is a major cause of death and disability. The aim of this study was to investigate the incidence of rebleeding and the risk factors related to rebleeding before early aneurysm repair.

Methods: The incidence of rebleeding, demographic data, and clinical data from 326 patients with aneurysmal subarachnoid hemorrhage (SAH) were retrospectively collected. All clinical variables were examined by univariate analysis, and a binary logistic regression analysis was performed to identify the risk factors related to rebleeding.

Results: Rebleeding occurred in 70 (21.5%) of the 326 aneurysm patients during transfer or during the in-hospital stay (within 72 hours); 24 episodes (34.3%) occurred within 3 hours, and 44 episodes (62.9%) occurred within 6 hours after the initial SAH. Univariate analysis showed that there were significant differences between the rebleeding and nonrebleeding patients in terms of age, aneurysm size, systolic arterial blood pressure (SBP), Hunt-Hess grade and outcome at discharge. The binary logistic regression analysis revealed that age (odds ratio [OR] = 1.167), aneurysm size (OR = 1.624), SBP (OR = 3.338), and Hunt-Hess grade (OR = 2.512) were independent risk factors for aneurysmal rebleeding (for each P < 0.05).

Conclusions: The incidence of early aneurysmal rebleeding within hours after the initial SAH is high during transfer or during the in-hospital stay. Advanced age, an aneurysm size larger than 10 mm, SBP higher than 160 mmHg, and poor Hunt-Hess grade were independent risk factors for aneurysmal rebleeding. The importance of early aneurysm repair should be emphasized because aneurysmal rebleeding contributes to a poor outcome.