title: Risk factors for three phases of 12-month mortality in 1657 patients from a defined population after acute aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  To analyze the impact of factors known after admission on mortality attributable to aneurysmal subarachnoid hemorrhage (SAH) resulting from saccular intracranial aneurysm (IA).
  
  
  METHODS
  Data of 1657 consecutive patients admitted alive within 24 hours after aneurysmal SAH to Kuopio Neurosurgery during the years 1980-2007 from a defined population were analyzed.
  
  
  RESULTS
  Aneurysmal SAH caused excess mortality for 12 months, after which other causes of death became dominant. The 12-month mortality curve on a logarithmic time scale indicated acute (first 3 days), subacute (4-30 days), and delayed (1-12 months) mortality, with cumulative rates of 11% at 3 days, 22% at 30 days, and 27% at 12 months. The acute mortality was predicted by Hunt & Hess (H&H) grades IV-V, ruptured aneurysm ≥ 15 mm, and acute subdural hematoma. Age, gender, intracerebral hemorrhage (ICH), and time period of admission were not independent risk factors. Advanced age, H&H grades IV-V, intraventricular hemorrhage (IVH), giant ruptured saccular IA, ruptured saccular IA on the internal carotid artery or the basilar artery bifurcation, and severe hydrocephalus in different combinations predicted subacute and delayed mortality. Patients in good condition on admission had a mortality rate of only 3.5% at 12 months, regardless of age.
  
  
  CONCLUSIONS
  Sequelae of aneurysmal SAH were the leading cause of death for 12 months. Mortality analysis of this period displayed three phases with distinct independent risk factors. These data support the creation of prognosticators for prediction on admission of the everyday individual risk of death until 12 months after aneurysmal SAH.
authors: Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors: Petros N
authors: PN
authors: Karamanakos
authors: Mikael
authors: M
authors: von Und Zu Fraunberg
authors: Stepani
authors: S
authors: Bendel
authors: Terhi
authors: T
authors: Huttunen
authors: Mitja
authors: M
authors: Kurki
authors: Juha
authors: J
authors: Hernesniemi
authors: Antti
authors: A
authors: Ronkainen
authors: Jaakko
authors: J
authors: Rinne
authors: Juha E
authors: JE
authors: Jaaskelainen
authors: Timo
authors: T
authors: Koivisto
mesh_terms: D000208:Acute Disease; D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality*; D015996:Survival Rate / Q000639:trends