In the intensive care unit in patients followed with spontaneous subarachnoid hemorrhage factors affecting mortalityretrospective analysis

In the Intensive Care Unit In Patients Followed with Spontaneous Subarachnoid Hemorrhage Factors Affecting Mortality Retrospective Analysis Introduction: Subarachnoid hemorrhage (SAH) is a high mortality and morbidity disease with high treatment costs. Our knowledge about the management of the follow-up and treatment process of patients with spontaneous SAH in the intensive care unit (ICU) is still lacking in general. Better management of this process is of great importance in terms of preventing morbidity and mortality related to the disease. The aim of this study was to determine the demographic/clinical characteristics and factors affecting the mortality of spontaneous SAH patients followed up in ICU. Materials and Methods: This study was designed as a retrospective cohort study including patients with spontaneous SAH who were followed up in the ICU between January 01, 2019 and December 31, 2023. Data were obtained from patient follow-up files and hospital information system database. Demographic data, diagnosis leading to spontaneous SAH, location and size of the aneurysm, presenting symptoms, risk factors, procedures performed for spontaneous SAH, disease severity scores during ICU hospitalization, complications, duration of mechanical ventilation and ICU stay were recorded. Patients were divided into two groups according to the outcome of the ICU process: survival and those who developed mortality. The causes of mortality and brain death were also recorded. Results: In total, data of 117 patients with spontaneous SAH were analyzed. Mortality rate was 41%. The mean age of the patients was 54,9±15,1 years and the majority (58,1%) were 50 years and older. The majority of patients (64,1%) had hypertension as a comorbidity and 57,2% of patients were hypertensive during ICU hospitalization. In the group of patients with mortality, admission with headache was lower and admission with loss of consciousness was significantly higher. Aneurysms were detected in 65 (55.6%) of the patients. The GCS score was lower, Acute Physiology and Chronic Health Evaluation-II (APACHE-II), World Federation of Neurosurgical Societies (WFNS), Hunt and Hess Scale (HHS) and Modified Fisher Scale scores were higher in the mortality group. During ICU follow-up, 38 (32,5%) patients had hydrocephalus, 36 (30,8%) had Delayed Cerebral Injury (DCI), 30 (25,6%) had hypernatremia and mortality was higher in this patient group. During ICU follow-up, 82 (70%) patients required mechanical ventilation. The mean ICU length of stay was 17,8±22,3 days and was longer in the mortality group. The most common cause of mortality was infective complications. In logistic regression analysis, loss of consciousness at admission, Charlson Comorbidity Index (CCI), GCS<8, HHS >2, meningitis and sepsis were found to be independent risk factors associated with mortality. Conclusion: In our study, ICU mortality in patients with spontaneous SAH was 41%. The results of our study showed that loss of consciousness, CCI, GCS <8, HHS >2, and complication status (meningitis and sepsis/septic shock) were independent risk factors associated with mortality. Keywords: Spontaneous subarachnoid hemorrhage, intensive care unit, mortality