• Maryam Said, Meltem Gümüs, Marvin Darkwah Oppong, Patrick Dömer, Simeon O A Helgers, Philipp Dammann, Karsten H Wrede, Johannes Woitzik, Ulrich Sure, and Ramazan Jabbarli.
• Department of Neurosurgery, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany. Electronic address: maryam.said@evangelischeskrankenhaus.de.
• World Neurosurg. 2024 Dec 4; 194: 123426123426.

ObjectiveAneurysmal subarachnoid hemorrhage (aSAH) has a high complications burden, with in-hospital mortality as the most devastating outcome. We aimed to develop and validate a risk score for early prediction of in-hospital mortality after aSAH.MethodsData from 2 university hospitals were pooled (n = 1070), with cohorts for score construction (n = 886) and external validation (n = 184). Several parameters assessable at admission were collected. Independent predictors of in-hospital mortality were used as mortality score components. Diagnostic accuracy of the novel score was compared to the Hunt and Hess Age, Intraventricular Hemorrhage, Rebleed and World Federation of Neurosurgical Societies (WFNS) scores.ResultsOverall rate of in-hospital mortality was 19% and 14.7% in construction and validation cohorts, respectively. The novel risk score (aSAH mortality score: 0-12 points) included patients' age (≤55 years: 0 points, 56-70 years: 1 point, >70 years: 2 points), aneurysm rebleeding (2 points), WFNS grade (grade I-II: 0 points, grade III-IV: 2 points, grade V: 5 points), and Hijdra sum score (≤10: 0 points, 11-20: 1 point, 21-30: 2 points, >30: 3 points). In-hospital mortality rates ranged 0.6% (0 points) to 100% (12 points) in the construction cohort, and 0% (0 points) to 60% (10 points) in the validation cohort. In the receiver operating characteristic analysis, the aneurysmal subarachnoid hemorrhage mortality score (area under the curve [AUC]: 0.829 and 0.824 in the construction and validation cohorts, respectively) was superior to the Hunt and Hess Age, Intraventricular Hemorrhage, Rebleed (AUC: 0.811 and 0.813) and WFNS scores (AUC: 0.768 and 0.795).ConclusionsRisk of in-hospital mortality after aSAH can be predicted with high accuracy using baseline characteristics. The novel risk score showed best diagnostic performance in the construction and validation cohorts and can aid in early prognostication and treatment decisions.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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