Lee Ho Seok, Sohn Min Kyun, Lee Jongmin, Kim Deog Young, Shin Yong-Il, Oh Gyung-Jae, Lee Yang-Soo, Joo Min Cheol, Lee So Young, Song Min-Keun, Han Junhee, Ahn Jeonghoon, Lee Young-Hoon, Kim Dae Hyun, Kim Young-Taek, Kim Yun-Hee, Chang Won Hyuk
Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
Int J Stroke. 2025 Aug;20(7):821-830. doi: 10.1177/17474930251320566. Epub 2025 Feb 24.
Aneurysmal subarachnoid hemorrhage (aSAH) remains a significant global health concern, and therefore, understanding their functional outcomes is essential. The aim of this study was to investigate the 1-year functional outcomes of patients with aSAH.
We retrospectively analyzed data of patients with aSAH from the Korean Stroke Cohort for Functioning and Rehabilitation study, up to 1 year post-onset. The cohort data were collected twice. The first data was collected from August 2012 through May 2015, and the second data was collected from January to December in 2020, from nine different hospitals. Assessments were performed from 7 days to 1 year. Disability, measured by modified Rankin Scale (mRS), was analyzed in terms of good outcome (mRS 0 or 1) and mortality. In addition, functional level was further assessed using Functional Independence Measure (FIM) in aSAH survivors at 1 year post-onset. A subgroup analysis was conducted, with participants further classified into two groups: one with mild-to-moderate disability (mRS 0-3) and another with severe disability (mRS 4 or 5), as reported 7 days after onset. Multiple imputation method was used to handle missing data. In addition, mixed-effects model was used to analyze the trajectory of FIM.
A total of 517 patients with aSAH were included. Of these, 246 (47.6%) showed mild-to-moderate disability and 271 (52.4%) showed severe disability at 7 days. At 1 year after onset, the mortality rate was 6.0% and the good outcome was reported in 76.2% of patients. In aSAH survivors at 1 year, FIM showed a significant improvement over time, with a significant difference demonstrated between the subgroups. Age, initial clinical severity, and cognitive function at 7 days were also identified as significant covariates.
The majority of patients reporting mild-to-moderate disability at 7 days exhibited good functional outcome, and even among those with severe disability, there was a favorable outcome with continuous improvement in their functional levels. Therefore, proper assessments and effective management should be employed to achieve favorable functional outcomes among aSAH survivors.
动脉瘤性蛛网膜下腔出血（aSAH）仍是全球重大的健康问题，因此，了解其功能转归至关重要。本研究旨在调查aSAH患者1年的功能转归情况。
我们回顾性分析了韩国卒中功能与康复队列研究中aSAH患者发病后长达1年的数据。队列数据收集了两次。首次数据收集于2012年8月至2015年5月，第二次数据收集于2020年1月至12月，来自9家不同医院。评估在发病7天至1年进行。采用改良Rankin量表（mRS）测量残疾情况，分析良好转归（mRS 0或1）和死亡率。此外，在发病1年后，使用功能独立性测量（FIM）对aSAH幸存者的功能水平进行进一步评估。进行亚组分析，参与者进一步分为两组：一组为轻度至中度残疾（mRS 0 - 3），另一组为重度残疾（mRS 4或5），这是发病7天后报告的情况。采用多重填补法处理缺失数据。此外，使用混合效应模型分析FIM的变化轨迹。
共纳入517例aSAH患者。其中，246例（47.6%）在7天时表现为轻度至中度残疾，271例（52.4%）表现为重度残疾。发病1年后，死亡率为6.0%，76.2%的患者报告转归良好。在发病1年的aSAH幸存者中，FIM随时间有显著改善，亚组间有显著差异。年龄、初始临床严重程度和发病7天时的认知功能也被确定为显著的协变量。
大多数在7天时报告为轻度至中度残疾的患者功能转归良好，即使在重度残疾患者中，其功能水平也持续改善，转归良好。因此，应采用适当的评估和有效管理措施，以使aSAH幸存者获得良好的功能转归。
