title: Prognostic Value of the Amount of Bleeding After Aneurysmal Subarachnoid Hemorrhage: A Quantitative Volumetric Study.
abstract: BACKGROUND
  Quantitative estimation of the hemorrhage volume associated with aneurysm rupture is a new tool of assessing prognosis.
  
  
  OBJECTIVE
  To determine the prognostic value of the quantitative estimation of the amount of bleeding after aneurysmal subarachnoid hemorrhage, as well the relative importance of this factor related to other prognostic indicators, and to establish a possible cut-off value of volume of bleeding related to poor outcome.
  
  
  METHODS
  A prospective cohort of 206 patients consecutively admitted with the diagnosis of aneurysmal subarachnoid hemorrhage to Hospital 12 de Octubre were included in the study. Subarachnoid, intraventricular, intracerebral, and total bleeding volumes were calculated using analytic software. For assessing factors related to prognosis, univariate and multivariate analysis (logistic regression) were performed. The relative importance of factors in determining prognosis was established by calculating their proportion of explained variation. Maximum Youden index was calculated to determine the optimal cut point for subarachnoid and total bleeding volume.
  
  
  RESULTS
  Variables independently related to prognosis were clinical grade at admission, age, and the different bleeding volumes. The proportion of variance explained is higher for subarachnoid bleeding. The optimal cut point related to poor prognosis is a volume of 20 mL both for subarachnoid and total bleeding.
  
  
  CONCLUSIONS
  Volumetric measurement of subarachnoid or total bleeding volume are both independent prognostic factors in patients with aneurysmal subarachnoid hemorrhage. A volume of more than 20 mL of blood in the initial noncontrast computed tomography is related to a clear increase in poor outcome risk.
  
  
  BACKGROUND
  : aSAH, aneurysmal subarachnoid hemorrhage.
authors: Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
authors: Alfonso
authors: A
authors: Lagares
authors: Luis
authors: L
authors: Jiménez-Roldán
authors: Pedro A
authors: PA
authors: Gomez
authors: Pablo M
authors: PM
authors: Munarriz
authors: Ana M
authors: AM
authors: Castaño-León
authors: Santiago
authors: S
authors: Cepeda
authors: José F
authors: JF
authors: Alén
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed