Risk factors and prognosis of malignant global cerebral edema in severe subarachnoid hemorrhage
WU Qian
REN Sen
WU Xiaohui
CHEN Jingcao
WANG Wei
Abstract：Objective To explore the risk factors and prognosis of malignant global cerebral edema(mGCE)in patients with severe subarachnoid hemorrhage(SaSAH).Methods A retrospective analysis was conducted on 394 patients with SaSAH(Hunt Hess Grade Ⅲ/Ⅳ)who underwent aneurysm surgery from January 2020 to December 2023 in Zhongnan Hospital of Wuhan University.Patients were divided into mGCE group(n=42)and control group(n=352)based on the mGCE occurrence during hospitalization.Clinical characteristics were compared,risk factors for mGCE were analyzed and the impacts of mGCE on prognosis were explored.Results The proportion of patients in the mGCE group with previous heart disease,Hunt Hess score of 4 points,SEBES score of 3-4 points,admission GCS score≤8 points,incidence of postoperative infection/DCI,emergency tracheal intubation rate,admission random lactate and highest plasma osmotic pressure levels were significantly higher than those in the control group,while the proportion of large-sized(11-25 mm)aneurysms in the mGCE group was significantly lower than that in the control group(P<0.05,P<0.01).The mortality rate of patients in the mGCE group was as high as 81%and neurological function of the survival patients at 3 and 6 months was poor.Age>60 years,female sex,emergent endotracheal intubation,Hunt-Hess score=4,and elevated random lactate on admission were independent risk factors for mGCE after SaSAH.Based on the relevant risk factors,a prediction model was constructed.The area under the ROC curve of the training set was 0.834(95%CI:0.752-0.891),the area under the ROC curve of the validation set was 0.781(95%CI:0.693-0.851),and the Hosmer-Lemeshow Goodness-of-Fit test(χ2=6.07,P=0.577).Previous cardiac disease,acute hydrocephalus requiring EVD,Hunt Hess score=4,number of complications≥2,and NLR value above 18.5 are independent risk factors affecting the long-term survival status of SaSAH with mGCE.Conclusions mGCE is an important cause of early mortality and poor prognosis of patients with SaSAH.
Keywords：severe aneurysmal subarachnoid hemorrhagemalignant cerebral edemaneuroinflammationrisk factorsprognosis
Publication Date：2025-10-28
Online Publishing Date：2025-10-09(First online date of this platform, not the publication date of the document)
Pages：7( 63-69 )