Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study

• Published in: PloS one Vol. 16; no. 8; p. e0256150
• Main Authors: Luong, Chinh Quoc, Ngo, Hung Manh, Hoang, Hai Bui, Pham, Dung Thi, Nguyen, Tuan Anh, Tran, Tuan Anh, Nguyen, Duong Ngoc, Do, Son Ngoc, Nguyen, My Ha, Vu, Hung Dinh, Vuong, Hien Thi Thu, Mai, Ton Duy, Nguyen, Anh Quang, Le, Kien Hoang, Dao, Phuong Viet, Tran, Thong Huu, Vu, Luu Dang, Nguyen, Linh Quoc, Pham, Trang Quynh, Dong, He Van, Nguyen, Hao The, Nguyen, Chi Van, Nguyen, Anh Dat
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.08.2021; Public Library of Science (PLoS)
• Subjects: Aged; Aneurysm; Aneurysm, Ruptured - pathology; Aneurysm, Ruptured - surgery; Aneurysms; Biology and Life Sciences; Cardiovascular system; Care and treatment; Cohort analysis; Confidence intervals; Critical care; Data collection; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - mortality; Emergency medical care; Endovascular coiling; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Health care policy; Health insurance; Hemorrhage; Hospitals; Humans; Hydrocephalus; Intracranial Aneurysm - pathology; Intracranial Aneurysm - surgery; Ischemia; Male; Medical imaging; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Neurology; Neurosurgery; Patient outcomes; Patients; People and Places; Pharmacy; Prognosis; Prospective Studies; Public health; Regression analysis; Research and Analysis Methods; Risk analysis; Risk Factors; Statistical analysis; Stroke; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - etiology; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - pathology; Supervision; Survival Rate; Treatment Outcome; Vietnam; Vietnam; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0256150

The prevalence of risk factors for poor outcomes from aneurysmal subarachnoid hemorrhage (SAH) varies widely and has not been fully elucidated to date in Vietnam. Understanding the risk and prognosis of aneurysmal SAH is important to reduce poor outcomes in Vietnam. The aim of this study, therefore, was to investigate the rate of poor outcome at 90 days of ictus and associated factors from aneurysmal SAH in the country. We performed a multicenter prospective cohort study of patients (≥18 years) presenting with aneurysmal SAH to three central hospitals in Hanoi, Vietnam, from August 2019 to August 2020. We collected data on the characteristics, management, and outcomes of patients with aneurysmal SAH and compared these data between good (defined as modified Rankin Scale (mRS) of 0 to 3) and poor (mRS, 4-6) outcomes at 90 days of ictus. We assessed factors associated with poor outcomes using logistic regression analysis. Of 168 patients with aneurysmal SAH, 77/168 (45.8%) were men, and the median age was 57 years (IQR: 48-67). Up to 57/168 (33.9%) of these patients had poor outcomes at 90 days of ictus. Most patients underwent sudden-onset and severe headache (87.5%; 147/168) and were transferred from local to participating central hospitals (80.4%, 135/168), over half (57.1%, 92/161) of whom arrived in central hospitals after 24 hours of ictus, and the initial median World Federation of Neurological Surgeons (WFNS) grading score was 2 (IQR: 1-4). Nearly half of the patients (47.0%; 79/168) were treated with endovascular coiling, 37.5% (63/168) were treated with surgical clipping, the remaining patients (15.5%; 26/168) did not receive aneurysm repair, and late rebleeding and delayed cerebral ischemia (DCI) occurred in 6.1% (10/164) and 10.4% (17/163) of patients, respectively. An initial WFNS grade of IV (odds ratio, OR: 15.285; 95% confidence interval, CI: 3.096-75.466) and a grade of V (OR: 162.965; 95% CI: 9.975-2662.318) were independently associated with poor outcomes. Additionally, both endovascular coiling (OR: 0.033; 95% CI: 0.005-0.235) and surgical clipping (OR: 0.046; 95% CI: 0.006-0.370) were inversely and independently associated with poor outcome. Late rebleeding (OR: 97.624; 95% CI: 5.653-1686.010) and DCI (OR: 15.209; 95% CI: 2.321-99.673) were also independently associated with poor outcome. Improvements are needed in the management of aneurysmal SAH in Vietnam, such as increasing the number of aneurysm repairs, performing earlier aneurysm treatment by surgical clipping or endovascular coiling, and improving both aneurysm repairs and neurocritical care.