# Aneurysmal subarachnoid hemorrhage-risk score—impact of pre-existing cardiovascular risk factors on functional patient outcomes

## TL;DR

This study creates a new risk score to predict long-term outcomes for patients with aneurysmal subarachnoid hemorrhage based on pre-existing cardiovascular factors.

## Contribution

The aSAH-Risk score is a novel clinical tool for early risk stratification of functional outcomes in aneurysmal subarachnoid hemorrhage patients.

## Key findings

- Five significant clinical variables were identified to predict unfavorable outcomes after aneurysmal subarachnoid hemorrhage.
- The aSAH-Risk score ranges from 40% to 80% risk of poor outcomes based on accumulated points from clinical factors.
- The score aims to identify patients likely to need long-term assistance following the hemorrhage.

## Abstract

Predictive tools for assessing outcomes after aneurysmal subarachnoid hemorrhage (aSAH) are limited, particularly with respect to long-term functional outcome. Reliable risk stratification in the early course of aSAH is crucial for determining optimal patient management, effective use of clinical resources, and ultimately improving patient outcomes. This study aimed to design a prognostic score based on retrospectively collected clinical variables to predict functional outcome or delayed cerebral ischemia as primary endpoints in patients with aSAH.

Between January 2014 and March 2022, 386 patients with aSAH were admitted to our hospital. Two hundred thirty of these patients were included in our study. Seventeen clinical, radiological, and demographic variables were analyzed using the chi-squared test and logistic regression to identify significant predictors of an unfavorable outcome (mRS 4–6) after 6 months or DCI development. A nomogram defined the weighting of each factor within a newly developed aSAH-Risk score.

Significant risk factors were identified to predict functional outcome. Of these, five variables were included to create the aSAH-Risk score with a maximum of 13 points: arterial hypertension (p = 0.001, no = 0, yes = 2), intracranial vasosclerosis (p = 0.0002, none = 0, yes = 2), modified Fisher scale (p < 0.001, scale 1 = 0, scale 3 = 2, scale 2 or 4 = 3), intracerebral hemorrhage (no = 1, yes = 2) and World Federation of Neursosurgical Societies grading (p < 0.001, 1 = 0, 2 = 1, 3 or 4 = 3, 5 = 4). Forty percent was the minimal calculated risk of an unfavorable outcome for an aSAH patient, increasing to 80% with an aSAH-Risk score of 13 points. An external cohort is required to validate the proposed score for general applicability.

The aSAH-Risk score is a novel clinical tool to identify patients in need of long-term daily life assistance at admission.