Introduction: Aneurysmal subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality(1). Delayed cerebral ischemia (DCI) is a major cause for poor outcome after SAH. Cerebral vasospasm is the primary driver of DCI, and the largest independent contributor to poor outcome after SAH (1). Prior studies have reported an association between fever and leukocytosis, and cerebral vasospasm. In this study, we assessed the utility of fever and/or leukocytosis to predict DCI after SAH.
Methods: We performed a retrospective analysis of 187 SAH patients. Univariate and multivariate logistic regression was performed to identify potential risk factors for three different endpoints - (a) Mild, Moderate, or Severe Angiographic Vasospasm, (b) Moderate or Severe Angiographic Vasospasm, and (c) Symptomatic DCI. Multiple independent variables including age, Hunt-Hess grade, modified Fisher grade, fever (T>/= 38.0 ºC), WBC >/= 10, WBC >/= 15, fever and WBC >/= 10, fever and WBC >/= 15 were examined over the course of each hospital stay.
Results: Presence of fever and/or leukocytosis were both significant predictors of symptomatic DCI. In addition, number of days with fever following aneurysm rupture was strongly associated with angiographic vasospasm, while number of days with WBC>/=15 was strongly associated with symptomatic DCI. When these variables were combined, number of days with concurrent fever and WBC>/=10 was an independent predictor of angiographic vasospasm, and number of days with concurrent fever and WBC>/=15 was an independent predictor of both angiographic vasospasm and symptomatic DCI. Time intervals of Day 0-3 and Day 3-7 after aneurysm rupture had the highest odds ratios for angiographic vasospasm.
Conclusions: Patients with aneurysmal SAH who had higher number of days with fever and/or leukocytosis after aneurysm rupture were more likely to have angiographic vasospasm and symptomatic DCI. Presence of fever and/or leukocytosis may have utility in assessing the risk of DCI following SAH.
Patient Care: Aneurysmal SAH is associated with significant mortality (average case fatality rate of 50%) and morbidity (30% of survivors become functionally dependent).1 Improving prediction of vasospasm may have utility in implementing therapeutic interventions for patient at higher risk.
Learning Objectives: By the conclusion of this session, participants should be able to
1. Understand the association of fever and angiographic vasospasm and symptomatic DCI following SAH
2. Understand the association of leukocytosis and angiographic vasospasm and symptomatic DCI following SAH
3. Understand the predictive value of fever and/or leukocytosis during time intervals following aneurysm rupture
References: 1. Linn FH, Rinkel GJ, Algra A, van Gijn J. Incidence of subarachnoid hemorrhage: Role of region, year, and rate of computed tomography: A meta-analysis. Stroke. 1996;27:625-629