Fatal aneurysmal subarachnoid haemorrhage: causes of 30-day in-hospital case fatalities in a large single-centre historical patient cohort.

BACKGROUND

Mortality rates of up to 40% in the early phase following an aneurysmal subarachnoid haemorrhage (SAH) indicate that the overall case-fatality rate is predominantly influenced by the initial phase of the disease. This analysis investigates the in-hospital causes of death (CODs) within 30 days of admission in patients suffering from a SAH.

METHODS

Of the 591 consecutive patients with SAHs from ruptured cerebral aneurysms, 85 patients who died within 30 days after admission were analysed. The various CODs were classified as cerebral or non-cerebral events. A Kaplan-Meier survival analysis was performed for the cerebral and non-cerebral CODs to identify the specific chronology of occurrence.

RESULTS

The median cumulative fatality was 4 days. A cerebral oedema as a result of initial brain damage after ictus was the predominant COD (n=24, 28.2%; median cumulative fatality, 1 day; IQR, 1-4 days; SEM, 0.680), followed by cerebral infarction caused by delayed cerebral ischaemia (DCI) (n=13, 15.3%; median cumulative fatality, 9 days; IQR, 4-13 days; SEM, 1.379). Renal failure was the predominant non-cerebral COD before cardiac and pulmonary complications (n=6, 7.1%).

CONCLUSIONS

Mortalities after SAHs predominantly occur within the first days after ictus. The dominant cerebral cause of death is early initial cerebral oedema, followed by DCI.