A recent systematic review and meta-analysis found there was a lack of consensus regarding risk factors for cerebral vasospasm in aneurysmal subarachnoid hemorrhage (aSAH).
To identify risk factors associated with increased likelihood of cerebral vasospasm following aSAH using the largest, all-payer, inpatient database in the U.S.
The Nationwide Readmissions Database (2016) was queried using ICD-10 codes to identify patients (age ≥ 18) treated (coiling or clipping) for aSAH. Exposure variables included demographics, comorbidities, location and clinical grade of aSAH, treatment type, and laboratory anomalies. Multivariable analysis was conducted to identify factors independently associated with cerebral vasospasm (ICD-10 code I67.84).
The rate of vasospasm was 28.1% in 8,346 patients with treated aSAH. In multivariable analysis, vasospasm risk was inversely proportional to age (P<0.001). Substance abuse, particularly tobacco smoking and cocaine, were associated with vasospasm (P<0.05). Advanced SAH severity (Hunt Hess 2 or greater) approximately doubled risk of vasospasm (P<0.001). Poor hemodynamic status, including anemia (OR: 1.8), hypovolemia (OR: 1.6), and hypotension (OR: 1.4) were correlated with vasospasm. Laboratory abnormalities, including leukocytosis (OR: 1.3), hyponatremia (OR: 1.4), and hypokalemia (OR: 1.3) were associated with vasospasm (all P<0.05).
In the first nationwide analysis of cerebral vasospasm, risk factors included younger age, female sex, smoking history, hemodynamic compromise, and clinical severity of aSAH. Recently proposed biomarkers, including leukocytosis and hypokalemia, were supported by our findings. This study may assist risk-stratification and earlier detection of vasospasm.
Copyright © 2020. Published by Elsevier Inc.