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Case-fatality and functional outcome after subarachnoid hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT)


Rehman, S and Phan, HT and Reeves, MJ and Thrift, AG and Cadilhac, DA and Sturm, J and Breslin, M and Callisaya, ML and Vemmos, K and Parmar, P and Krishnamurthi, RV and Barker-Collo, S and Feigin, V and Chausson, N and Olindo, S and Cabral, NL and Carolei, A and Marini, C and Degan, D and Sacco, S and Correia, M and Appelros, P and Korv, J and Vibo, R and Minelli, C and Sposato, L and Pandian, JD and Kaur, P and Azarpazhooh, MR and Morovatdar, N and Gall, S, Case-fatality and functional outcome after subarachnoid hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT), Journal of Stroke and Cerebrovascular Diseases, 31, (1) Article 106201. ISSN 1052-3057 (2022) [Refereed Article]

Copyright Statement

Copyright 2021 Elsevier Inc.

DOI: doi:10.1016/j.jstrokecerebrovasdis.2021.106201


Background: There are few large population-based studies of outcomes after subarachnoid hemorrhage (SAH) than other stroke types.

Methods: We pooled data from 13 population-based stroke incidence studies (10 studies from the INternational STRroke oUtComes sTudy (INSTRUCT) and 3 new studies; N=657). Primary outcomes were case-fatality and functional outcome (modified Rankin scale score 3-5 [poor] vs. 0-2 [good]). Harmonized patient-level factors included age, sex, health behaviours (e.g. current smoking at baseline), comorbidities (e.g.history of hypertension), baseline stroke severity (e.g. NIHSS >7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints.

Results: Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year.

Conclusion: Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.

Item Details

Item Type:Refereed Article
Keywords:subarachnoid hemorrhage, case-fatality, functional outcome, short-term outcome, long-term outcome, stroke, fatality predictors
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Rehman, S (Dr Sabah Rehman)
UTAS Author:Phan, HT (Dr Hoang Phan)
UTAS Author:Breslin, M (Dr Monique Breslin)
UTAS Author:Callisaya, ML (Dr Michele Callisaya)
UTAS Author:Gall, S (Associate Professor Seana Gall)
ID Code:150796
Year Published:2022
Web of Science® Times Cited:2
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-06-30
Last Modified:2022-09-28

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