Dataset Information

Impact of Fludrocortisone on the Outcomes of Subarachnoid Hemorrhage Patients: A Retrospective Analysis.

ABSTRACT:

Background

Whether the use of fludrocortisone affects outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) and its usage rate in the United States remain unknown.

Methods

We conducted a retrospective analysis of 78 consecutive patients with a ruptured aSAH at a single academic center in the United States. The primary outcome was the score on the modified Rankin scale (mRS, range, 0 [no symptoms] to 6 [death]) at 90 days. We adjusted the primary outcome for age, hypertension, aSAH grade, and time from aSAH onset to aneurysm treatment. Secondary outcomes were brain and cardiopulmonary dysfunction events.

Results

Among 78 patients at a single center, the median age was 58 years [IQR, 49 to 64.5]; 64% were female, and 41 (53%) received fludrocortisone. The adjusted common odds ratio, aOR, of a proportional odds regression model of fludrocortisone use with mRS was 0.33 (95% CI, 0.14-0.80; P=0.02), with values <1.0 favoring fludrocortisone. Organ-specific dysfunction events were not statistically different: delayed cerebral ischemia (22% vs. 39%, P=0.16); cardiac dysfunction (0% vs. 11%; P=0.10); and pulmonary edema (15% vs. 8%; P=0.59).

Conclusions

The risk of disability or death at 90 days was lower with the use of fludrocortisone in aSAH patients.

SUBMITTER: Mistry AM

PROVIDER: S-EPMC10557818 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Impact of Fludrocortisone on the Outcomes of Subarachnoid Hemorrhage Patients: A Retrospective Analysis.

Mistry Akshitkumar M AM Naidugari Janki J Feldman Michael J MJ Magarik Jordan A JA Ding Dale D Abecassis Isaac J IJ Semler Matthew W MW Rice Todd W TW

medRxiv : the preprint server for health sciences 20230929

<h4>Background</h4>Whether the use of fludrocortisone affects outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) and its usage rate in the United States remain unknown.<h4>Methods</h4>We conducted a retrospective analysis of 78 consecutive patients with a ruptured aSAH at a single academic center in the United States. The primary outcome was the score on the modified Rankin scale (mRS, range, 0 [no symptoms] to 6 [death]) at 90 days. We adjusted the primary outcome for age, hype ...[more]

PMID: 37808869

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Project description:ObjectiveA scoring system for aneurysmal subarachnoid hemorrhage (aSAH) is useful for guiding treatment decisions, especially in urgent-care limited settings. This study developed a simple algorithm of clinical conditions and grading to predict outcomes in patients treated by clipping or coiling.MethodsData on patients with aSAH hospitalized in a university's neurovascular center in Thailand from 2013 to 2018 were obtained for chart review. Factors associated with poor outcomes evaluated at one year were identified using a stepwise logistic regression model. For each patient, the rounded regression coefficients of independent risk factors were linearly combined into a total score, which was assessed for its performance in predicting outcomes using receiver operating characteristic analysis. An appropriate cutoff point of the scores for poor outcomes was based on Youden's criteria, which maximized the summation between sensitivity or true positive rate and the specificity or true negative rate.ResultsPatients (n, 121) with poor outcomes (modified Rankin Scale, mRS score, 4-6) had a significantly higher proportion of old age, underlying hypertension, diabetes and chronic kidney disease, high clinical severity grading, preoperative rebleeding, and hydrocephalus than those (n, 336) with good outcomes (mRS score, 0-3). Six variables, including age >70 years, diabetes mellitus, World Federation of Neurosurgical Societies (WFNS) scaling of IV-V, modified Fisher grading of 3-4, rebleeding, and hydrocephalus, were identified as independent risk factors and were assigned a score weight of 2, 1, 2, 1, 3 and 1, respectively. Among the total possible scores ranging from 0-10, the cut point at score 3 yielded the maximum Youden's index (0.527), which resulted in a sensitivity of 77.7% and specificity of 75.0%.ConclusionA simple 0-10 scoring system on six risk factors for poor outcomes was validated for aSAH and should be advocated for use in limited resource settings.

Dataset Information

Impact of Fludrocortisone on the Outcomes of Subarachnoid Hemorrhage Patients: A Retrospective Analysis.

Background

Methods

Results

Conclusions

Publications

Impact of Fludrocortisone on the Outcomes of Subarachnoid Hemorrhage Patients: A Retrospective Analysis.

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