title: Impact of intraventricular hemorrhage measured by Graeb and LeRoux score on case fatality risk and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Reliable prognostic tools to estimate the case fatality rate (CFR) and the development of chronic hydrocephalus (CHC) in aneurysmal subarachnoid hemorrhage (SAH) are not well defined. This study aims to investigate the practicability and reliability of Fisher, Graeb, and LeRoux scores for SAH patient prognosis.
  
  
  METHODS
  A total of 206 patients with aneurysmal SAH were retrospectively analyzed in prediction of CFR and CHC. Clinical data was evaluated and grading was performed using Fisher, Graeb, and LeRoux scores. Univariate and multivariate analyses were performed to identify relevant predictive parameters.
  
  
  RESULTS
  CFR was 17.0 % and was associated with higher age, higher Hunt & Hess (H&H) grade, lower Glasgow Coma Scale (GCS) at admission, as well as a higher Fisher, Graeb, and LeRoux score (p < 0.001). There were 19.9 % that developed CHC requiring permanent cerebrospinal fluid diversion. Low initial GCS (p = 0.003), high H&H (p < 0.001), intracerebral hematoma (p = 0.003), high Fisher (p = 0.047), Graeb and LeRoux scores (p < 0.001) were associated with a higher rate of ventricular-peritoneal shunting (VPS) in surviving patients. In multivariate analyses, Graeb score (odds ratio (OR) 1.183 [1.027, 1.363], p = 0.020), LeRoux score (OR 1.120 [1.013-1.239, p = 0.027), and H&H (OR 2.715 [1.496, 4.927], p = 0.001) remained independent prognostic factors for VPS.
  
  
  CONCLUSIONS
  Graeb or LeRoux scores improve the prediction of shunt dependency and in parts of CFR in aneurysmal SAH patients therefore confirming the relevance of the extent and distribution of intraventricular blood for the clinical course in SAH.
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany, p.czorlich@uke.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Czorlich
authors.forename: Franz
authors.initials: F
authors.lastname: Ricklefs
authors.forename: Matthias
authors.initials: M
authors.lastname: Reitz
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.forename: Tammam
authors.initials: T
authors.lastname: Abboud
authors.forename: Jan
authors.initials: J
authors.lastname: Regelsberger
authors.forename: Manfred
authors.initials: M
authors.lastname: Westphal
authors.forename: Nils Ole
authors.initials: NO
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000175:diagnosis*; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis*