CT Quantification of Intraventricular Hemorrhage Volume in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Impact on Mortality and Long-Term Disability.
Authors
Affiliations (35)
Affiliations (35)
- Functional and Molecular Neuroimaging Program, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
- Department of Neuroradiology, Vito-Fazzi Hospital, Lecce, Italy.
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences, University "Aldo Moro" of Bari, Bari, Italy.
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Department of Anaesthesia and Critical Care, Vito-Fazzi Hospital, Lecce, Italy.
- Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Department of Neurosurgery, Ospedale Vito Fazzi, Lecce, Italy.
- Anesthesia and Neuro Intensive Care Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Institute of Radiological Sciences, Fondazione Policlinico Universitario A.Gemelli IRCCS Catholic University of Rome, Rome, Italy.
- School of Medicine, University of Bologna, Bologna, Italy.
- Department of Neurosurgery, Fondazione Policlinico Universitario A.Gemelli IRCCS Catholic University of Rome, Rome, Italy.
- Department of Anesthesia and Critical Care Medicine Fondazione, Policlinico Universitario A.Gemelli IRCCS Catholic University of Rome, Rome, Italy.
- Department of Neuroradiology, University of Verona, Verona, Italy.
- Institute of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
- Anesthesia and Intensive Care A, Integrated University Hospital, Verona, Italy.
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
- Department of Neuroradiology Spedali, Civili University Hospital, Brescia, Italy.
- Department of Radiology, SS Annunziata Hospital, Taranto, Italy.
- Department of Critical Care, SS Annunziata Hospital, Taranto, Italy.
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
- Department of Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
- Anesthesia and Critical Care, University of Eastern Piedmont, Novara, Italy.
- Department of Radiology, University of Eastern Piedmont, Novara, Italy.
- Department of Neurosurgery, University of Eastern Piedmont, Novara, Italy.
- Neuro-Anesthesiology and Intensive Care Unit, AOU Careggi University Hospital, Florence, Italy.
- Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy.
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), Neurosurgery Clinic, Careggi University Hospital and University of Florence, Florence, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Neurocritical Care, Vita-Salute San Raffaele University, Milan, Italy.
- Hôpital Neurologique Pierre Wertheimer, Neuroradiologie Interventionelle, Lyon, France.
- Department of Neurosurgery, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Neuroradiology, Interventional Neuroradiology Division and Department of Neurosurgery, IRCCS San Raffaele University Hospital, Via Olgettina 60, 20132, Milan, Italy.
- Department of Neurosurgery, Vita-Salute San Raffaele University, Milan, Italy. [email protected].
- Department of Neuroradiology, Interventional Neuroradiology Division and Department of Neurosurgery, IRCCS San Raffaele University Hospital, Via Olgettina 60, 20132, Milan, Italy. [email protected].
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition with high morbidity and mortality, particularly in poor-grade patients (World Federation of Neurosurgical Societies grades IV-V). Intraventricular hemorrhage (IVH) is associated with worse outcomes, but its predictive value and interaction with demographic and clinical factors remain unclear. To evaluate the prognostic value of IVH volume (IVHV) quantified on admission computed tomography (CT) in association with mortality and long-term disability, as well as its interaction with demographic and clinical variables in patients with poor-grade aSAH. We retrospectively analyzed all consecutive patients with poor-grade aSAH and IVH that were admitted to nine Italian tertiary centers between 1 January 2015 and 31 May 2023. Bivariate and multivariable analyses were performed to identify factors associated with mortality and disability (modified Rankin Scale [mRS]). Global intracranial hemorrhage volume (GHV) as well as the volumes of ICH (ICHV), IVH (IVHV), and SAH (SAHV) were calculated by means of analytical software in a semiautomated setting. We employed an explainable machine learning approach to examine the interplay between hemorrhage volume distribution, demographic and clinical variables to define prognostic thresholds, and to develop a decision tree model. Among 326 patients with IVH (median age 61 years [IQR: 53-70], 65.6% male), IVHV was the strongest factor independently associated with mortality and disability. An IVHV threshold of 8 mL optimized sensitivity and specificity for the outcome. Combining IVHV with age and ICHV further improved prognostic thresholds in the studied population; specificity was 92% for mortality and 71% sensitivity for disability. Adding IVHV to the SAFIRE scale significantly improved its predictive power (De Long p .008). IVHV is a key factor associated with mortality and disability in poor-grade aSAH with intraventricular involvement. Quantifying hemorrhage volume on admission CT is a valuable tool for improving outcome stratification and guiding clinical decision-making.