# Investigating the Relationship between Demographic, Radiological and Clinical Factors and In-Hospital Mortality of Non-Traumatic Subarachnoid Hemorrhage Before and After COVID-19 Pandemic: Mortality in Non-Traumatic SAH Before and After COVID-19

## TL;DR

This study examines how factors like age, blood pressure, and pandemic timing affect mortality in patients with non-traumatic subarachnoid hemorrhage.

## Contribution

The study identifies new predictors of in-hospital mortality in non-traumatic SAH and evaluates changes during the pandemic.

## Key findings

- Lower GCS scores and higher systolic blood pressure at admission predict mortality in non-traumatic SAH.
- Mortality rates trended higher during the late-pandemic period, though not statistically significant.
- Angiography use decreased during the pandemic, potentially affecting patient outcomes.

## Abstract

Subarachnoid hemorrhage (SAH) is a life-threatening neurological condition
that accounts for approximately 5% of all strokes. This study aimed to
evaluate the demographic, clinical, and radiological factors associated with
in-hospital mortality in patients with non-traumatic SAH and to assess
potential differences before and after the COVID-19 pandemic.

This retrospective analytical study was conducted on 177 patients with
non-traumatic SAH admitted to Imam Hossein Hospital, Tehran, from November
2021 to December 2022. Diagnosis was confirmed by a neurologist using
clinical presentation, imaging, and cerebrospinal fluid analysis. Patients
were grouped based on discharge status (deceased vs. survived), and also
classified into early- and late- pandemic subgroups based on their admission
date. Comparative analyses and binary logistic regression were performed to
identify predictors of in-hospital mortality.

Among 177 patients (mean age: 54.75 years), 36 (20.3%) died during
hospitalization. Blood pressure, blood sugar, and level of consciousness at
admission were significantly associated with mortality (P 0.05), as were
disease severity (Hunt and Hess grade) and angiography status (P 0.001). No
significant associations were found for age, sex, hospitalization duration,
creatinine, platelets, hypertension, diabetes, or aneurysm characteristics
(P 0.05). Logistic regression identified lower Glasgow Coma Scale (GCS)
scores (P 0.001) and higher systolic blood pressure (P = 0.004) as
independent predictors of mortality. Mortality was higher in the
late-pandemic group (23.9% vs. 16.0%), though not statistically significant
(P = 0.18).

Lower GCS scores and elevated systolic blood pressure at admission were
independent predictors of in-hospital mortality in patients with
non-traumatic SAH. The COVID-19 pandemic period was associated with reduced
use of angiography and a trend toward increased mortality, underscoring the
importance of maintaining access to timely care during public health crises.