Delayed cerebral ischemia (DCI) is a major factor involved in the 30% morbidity and mortality rate in patients within two weeks after aneurysmal subarachnoid hemorrhage. The pathophysiology of DCI has not been clearly defined, although the phenomenon called cerebral vasospasm plays major role in developing DCI. Prognostic risk factors of DCI are also not established, therefore their investigation would allow better prognosis assessment in these patients.
DCI was defined as a decrease of neurological condition and was confirmed by excluding other possible causes of deterioration. The patients medical history, findings on-admission, status on the 1st post-operative day and the outcome were all measured and used to estimate the differences between the DCI and the non-DCI patients. All data were statistically analyzed using cross tabulations, parametric or non-parametric tests.
Six patients experienced DCI (14.6%), on average on the 5th day (peak on the 3rd day). DCI patients were initially in a worse clinical condition (World Neurosurgical Federation Surgeons scale 2.5 vs. 1.5, P=0.03) than the patients who did not experience DCI during the trial period. On the 1st postoperative day, the patients who developed DCI had a significantly lower fluid output (3417 vs. 2693 ml; P =0.04) and a lower positive to negative fluid balance ratio (50% to 90.9%; P=0.03). The patients with DCI had a significantly higher incidence of clinical complications and worse outcomes.
Our study shows that initial neurological status is the most predictive value of further experiencing of DCI. Other patient-related prognostic risk factors have a lesser influence.