title: Aneurysm rebleeding after poor-grade aneurysmal subarachnoid hemorrhage: Predictors and impact on clinical outcomes.
abstract: BACKGROUND
  Aneurysm rebleeding is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH) and more often occurs in patients with poor-grade aSAH. Limited data on predictors of rebleeding in these patients are available.
  
  
  OBJECTIVE
  To investigate predictors of aneurysm rebleeding after poor-grade aSAH and the association of rebleeding with clinical outcomes.
  
  
  METHODS
  A multicenter poor-grade aneurysm study was a prospective and observational registry of consecutive patients who presented with poor-grade aSAH defined as a World Federation of Neurosurgical Societies (WFNS) grade of IV or V. Rebleeding was defined as a new hemorrhage on computed tomography scan. Clinical outcomes were assessed with modified Rankin score. Multivariate logistic regression analyses were used to determine independent predictors of rebleeding and association between the rebleeding and clinical outcomes at 12months.
  
  
  RESULTS
  Of the 297 patients included in this study, 30 (10.1%) patients experienced rebleeding. Most rebleeding occurred within 24h after ictus. 22 (73.3%) patients died at discharge. Aneurysm rebleeding was independently associated with poor outcome (odds ratio [OR] 36.37, p<0.001) and associated with mortality (OR 25.03, p<0.001) at 12months. The multivariate analysis showed that a lower Fisher grade (OR 0.49, 95% CI 0.31-0.77; p=0.002), ruptured anterior cerebral artery aneurysms (OR 4.26, 95% CI 1.07-16.90; p=0.039), external ventricular drainage (OR 4.62, 95% CI 1.46-14.59; p=0.009) were independently associated with aneurysm rebleeding.
  
  
  CONCLUSIONS
  The outcome of aneurysm rebleeding remains very poor. A lower Fisher grade, ruptured anterior cerebral artery aneurysms, external ventricular drainage were associated with increased risk of rebleeding.
authors.affiliation: Department of Neurosurgery, Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Yilin
authors.initials: Y
authors.lastname: Fan
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 Neurology, The General Hospital of Lanzhou Military Command, Lanzhou, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Yin
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: Xianxi
authors.initials: X
authors.lastname: Tan
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. Electronic address: zhongming158@sohu.com.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aneurysm rebleeding; Intracranial aneurysm; Outcome; Poor-grade; Risk factor; Subarachnoid hemorrhage