Effect of non-neurological complications on the functional outcome of patients with ruptured intracranial aneurysms

Abstract

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening pathology associated with significant neurological and non-neurological complications. While the impact of neurological factors has been extensively studied, the impact of non-neurological complications remains underexplored. This study aimed to assess the effect of non-neurological complications on hospital stay and functional outcomes of patients with ruptured intracranial aneurysms (IAs). Methods: A retrospective cohort study assessed patients with ruptured IAs treated within a neurovascular program of a tertiary hospital between October 2019 and September 2023. Inclusion criteria were: ≥18 years old, confirmed aSAH, and available follow-up information. The primary outcome corresponded to non-excellent functional outcomes at 6- and 12-month follow-ups. Secondary outcomes included length of in-hospital and intensive care unit (ICU) stay. Multivariate logistic regression models, adjusted for age, sex, and baseline World Federation of Neurosurgical Societies (WFNS) scores, were conducted. Results: A total of 220 patients were included in this study, with a mean age of 56.66 ± 13.79 years; 74.5% were female. The most prevalent non-neurological complications were isolated fever (56.4%), arrhythmias (44.1%), and urinary tract infections (38.6%). Patients with poor neurological presentation had a higher prevalence of non-neurological complications. Pneumonia, pulmonary embolism, hyperglycemia, as well as fever were associated with higher odds of non-excellent functional outcomes (mRS 2–6) at 6- and 12-month follow-ups. Conclusions: Non-neurological complications significantly impact hospital stay and functional recovery in aSAH patients. Early diagnosis and intervention, as well as the implementation of comprehensive clinical algorithms, are crucial for improving long-term outcomes in patients with ruptured IAs.