Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Internal Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Eur Stroke J. 2024 Mar;9(1):200-208. doi: 10.1177/23969873231198324. Epub 2023 Sep 4.
Incidence of atraumatic subarachnoid hemorrhage (SAH) is decreasing over time and its treatment is changing. We reported epidemiologic data on aneurysmal (a-) and non-aneurysmal (na-) SAH over 10 years.
Our prospective population-based registry included patients with first-ever SAH occurring from January 2011 to December 2020. Clinical and neuroimaging records were screened to evaluate the presence and location of intracranial aneurysms, to identify naSAH subtypes and to retrieve information on surgical treatments. Incidence rates were standardized to the 2011 Italian and European population. We also estimated 30-day and 1-year case-fatality rates after SAH. Multivariate hazard ratios for 30-days and 1-year fatality were estimated with Cox regression analysis.
194 patients (60.8% women; mean age 62.5 ± 16.0 years) were included (76.8% aSAH and 23.2% naSAH). The crude incidence rates per 100,000 person-years of SAH, aSAH, and naSAH were 6.5 (95% CI 5.6-7.5), 5.0 (95% CI 4.2-5.9), and 1.5 (95% CI 1.1-2.0), respectively, and remained stable over time. Compared to aSAH, naSAH patients had higher age (68.8 ± 19.7 yearsvs 60.6 ± 14.2 years; = 0.012), lower cigarette smoking (17.9%vs 36.4%; < 0.001) and higher atrial fibrillation (15.7% vs 2.8%; = 0.005). SAH case-fatality rates within 30-days and 1-year were 28.4% (95% CI 21.4-36.9) and 37.1% (95% CI 29.0-46.7), respectively. The relative proportion of surgically treated patients did not change over time.
We found a low and stable incidence of SAH over the 2011-2020 period. naSAH remained rare and deserves further investigation in larger prospective cohorts.
创伤性蛛网膜下腔出血（SAH）的发病率随时间呈下降趋势，其治疗方法也在发生变化。我们报告了 10 年来关于颅内动脉瘤性（a-）和非动脉瘤性（na-）SAH 的流行病学数据。
我们的前瞻性基于人群的登记包括 2011 年 1 月至 2020 年 12 月期间首次发生的 SAH 患者。筛选临床和神经影像学记录，以评估颅内动脉瘤的存在和位置，确定 naSAH 亚型，并检索手术治疗信息。发病率按 2011 年意大利和欧洲人口进行标准化。我们还估计了 SAH 后 30 天和 1 年的病死率。使用 Cox 回归分析估计 30 天和 1 年病死率的多变量风险比。
共纳入 194 例患者（60.8%为女性；平均年龄 62.5 ± 16.0 岁）（76.8%为 aSAH，23.2%为 naSAH）。SAH、aSAH 和 naSAH 的每 100,000 人年粗发病率分别为 6.5（95%CI 5.6-7.5）、5.0（95%CI 4.2-5.9）和 1.5（95%CI 1.1-2.0），且随时间保持稳定。与 aSAH 相比，naSAH 患者年龄更大（68.8 ± 19.7 岁比 60.6 ± 14.2 岁；= 0.012），吸烟率更低（17.9%比 36.4%；< 0.001），心房颤动发生率更高（15.7%比 2.8%；= 0.005）。30 天和 1 年的 SAH 病死率分别为 28.4%（95%CI 21.4-36.9）和 37.1%（95%CI 29.0-46.7）。接受手术治疗的患者比例在不同时间没有变化。
我们发现 2011-2020 年期间 SAH 的发病率较低且稳定。naSAH 仍然很少见，值得在更大的前瞻性队列中进一步研究。
