• Pedro Kurtz, Fabio Silvio Taccone, Fernando A Bozza, Leonardo S L Bastos, Cassia Righy, Bruno Gonçalves, Ricardo Turon, Maristela Medeiros Machado, Marcelo Maia, Marcus A Ferez, Carlos Nassif, Marcio Soares, and SalluhJorge I FJIFD ́Or Institute for Research and Education, Rio de Janeiro, Brazil.Postgraduate Program, Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil..
• Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil. kurtzpedro@mac.com.
• Neurocrit Care. 2021 Aug 1; 35 (1): 56-61.

Background And PurposeAcute physiologic derangements and multiple organ dysfunction are common after subarachnoid hemorrhage. We aimed to evaluate the simplified acute physiology score 3 (SAPS-3) and the sequential organ failure assessment (SOFA) scores for the prediction of in-hospital mortality in a large multicenter cohort of SAH patients.MethodsThis was a retrospective analysis of prospectively collected data from 45 ICUs in Brazil, during 2014 and 2015. Patients admitted with non-traumatic subarachnoid hemorrhage (SAH) were included. Clinical and outcome data were retrieved from an electronic ICU quality registry. SAPS-3 and SOFA scores, without the neurological components (i.e., nSAPS-3 and nSOFA, respectively) were recorded, as well as the World Federation of Neurological Surgeons (WFNS) scale. We used multilevel logistic regression analysis to identify factors associated with in-hospital mortality. We evaluated performance using the area under the receiver operating characteristic curve (AUROC), as well as calibration belts and precision-recall plots.ResultsThe study included 997 patients, from which 426 (43%) had poor clinical grade (WFNS 4 or 5) and in-hospital mortality was 34%. Median nSAPS-3 and nSOFA score at admission were 46 (IQR: 38-55) and 2 (0-5), respectively. Non-survivors were older, had higher nSAPS-3 and nSOFA, and more often poor grade. After adjustment for age, poor grade and withdrawal of life sustaining therapies, multivariable analysis identified nSAPS-3 and nSOFA score as independent clinical predictors of in-hospital mortality. The AUROC curve that included nSAPS-3 and nSOFA scores significantly improved the already good discrimination and calibration of age and WFNS to predict in-hospital mortality (AUROC: 0.89 for the full final model vs. 0.85 for age and WFNS; P < 0.0001).ConclusionsnSAPS-3 and nSOFA scores were independently associated with in-hospital mortality after SAH. The addition of these scores improved early prediction of hospital mortality in our cohort and should be integrated to other specific prognostic indices in the early assessment of SAH.© 2020. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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