• Martin Nikolaus Stienen, Menno Germans, Jan-Karl Burkhardt, Marian C Neidert, Christian Fung, David Bervini, Daniel Zumofen, Michel Röthlisberger, Serge Marbacher, Rodolfo Maduri, Thomas Robert, Martin A Seule, Philippe Bijlenga, Karl Schaller, Javier Fandino, Nicolas R Smoll, Nicolai Maldaner, Sina Finkenstädt, Giuseppe Esposito, Bawarjan Schatlo, Emanuela Keller, Oliver Bozinov, Luca Regli, and Swiss SOS Study Group.
• From the Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland (M.N.S., M.G., J.-K.B., M.C.N., N.M., S.F., G.E., E.K., O.B., L.R.); Department of Neurosurgery, Inselspital Bern, Switzerland (C.F., D.B.); Department of Neurosurgery, University Hospital Basel, Switzerland (D.Z., M.R.); Department of Neurosurgery, Kantonsspital Aarau, Switzerland (S.M., J.F.); Department of Neurosurgery, University Hospital Lausanne, Switzerland (R.M.); Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland (T.R.); Department of Neurosurgery, Kantonsspital St.Gallen, Switzerland (M.A.S.); Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland (P.B., K.S., N.R.S.); and Department of Neurosurgery, University Hospital Göttingen, Germany (B.S.). mnstienen@gmail.com.
• Stroke. 2018 Feb 1; 49 (2): 333-340.

Background And PurposeTo identify predictors of in-hospital mortality in patients with aneurysmal subarachnoid hemorrhage and to estimate their impact.MethodsRetrospective analysis of prospective data from a nationwide multicenter registry on all aneurysmal subarachnoid hemorrhage cases admitted to a tertiary neurosurgical department in Switzerland (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]; 2009-2015). Both clinical and radiological independent predictors of in-hospital mortality were identified, and their effect size was determined by calculating adjusted odds ratios (aORs) using multivariate logistic regression. Survival was displayed using Kaplan-Meier curves.ResultsData of n=1866 aneurysmal subarachnoid hemorrhage patients in the Swiss SOS database were available. In-hospital mortality was 20% (n=373). In n=197 patients (10.6%), active treatment was discontinued after hospital admission (no aneurysm occlusion attempted), and this cohort was excluded from analysis of the main statistical model. In the remaining n=1669 patients, the rate of in-hospital mortality was 13.9% (n=232). Strong independent predictors of in-hospital mortality were rebleeding (aOR, 7.69; 95% confidence interval, 3.00-19.71; P<0.001), cerebral infarction attributable to delayed cerebral ischemia (aOR, 3.66; 95% confidence interval, 1.94-6.89; P<0.001), intraventricular hemorrhage (aOR, 2.65; 95% confidence interval, 1.38-5.09; P=0.003), and new infarction post-treatment (aOR, 2.57; 95% confidence interval, 1.43-4.62; P=0.002).ConclusionsSeveral-and among them modifiable-factors seem to be associated with in-hospital mortality after aneurysmal subarachnoid hemorrhage. Our data suggest that strategies aiming to reduce the risk of rebleeding are most promising in patients where active treatment is initially pursued.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT03245866.© 2018 American Heart Association, Inc.

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