title: Predictors of good functional outcomes and mortality in patients with severe rebleeding after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Aneurysmal rebleeding is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH); however, limited data on severity of rebleeding and outcomes after severe rebleeding are available. We aimed to determine predictors of good outcome and mortality after severe rebleeding.
  
  
  METHODS
  In a multicenter poor-grade aneurysm study, 60 patients with severe rebleeding, defined as new hemorrhage with poor clinical condition caused by rebleeding, were identified. Good functional outcome was defined as a modified Rankin scale (mRS) of ≤2, and mortality was defined as a mRS of 6. Multivariate logistic analyses were used to determine predictors of good outcome and mortality.
  
  
  RESULTS
  Of the 58 patients included in this report, 24 (41.3%) patients experienced rebleeding within 24h after ictus. 42 (72.4%) patients had died at 12 months. The rate of good outcome increased from 5.2% at discharge to 13.8% at 6 months and 19.0% at 12 months. In multivariate analysis, World Federation of Neurosurgical Societies (WFNS) grade IV after rebleeding (P=0.007) and aggressive treatment (P=0.039) were independently associated with good outcome. A higher modified Fisher grade before rebledding (P=0.040), larger aneurysms (P=0.005), and lower Glasgow coma score after rebleeding (P=0.003) were independently associated with increased mortality.
  
  
  CONCLUSIONS
  A better clinical condition after rebleeding were independently associated with good outcome and inversely associated with morality after severe rebleeding. Despite high mortality of rebleeding, patients with WFNS grade IV treated with aggressive treatment were more likely to have good outcomes regardless of their condition before rebleeding.
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Kuang
authors.initials: K
authors.lastname: Zheng
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Zequn
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Xianxi
authors.initials: X
authors.lastname: Tan
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: zhongming158@sohu.com.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Intracranial aneurysm; Outcome; Rebleeding; Risk factors; Subarachnoid hemorrhage