The prognostic significance of the Kerdo Index in the course of ruptured cerebral arterial aneurysms

Aneurysmal subarachnoid hemorrhage (aSAH) is frequently complicated by cardiac dysfunction, which is believed to result from excessive sympathetic nervous system (SNS) activation. Catecholamine surge following acute intracranial pressure elevation may provoke myocardial injury, electrocardiographic (ECG) abnormalities, and autonomic dysregulation. These systemic responses contribute to poor outcomes and underscore the relevance of cardiocerebral interactions in aSAH pathophysiology. Objective — to evaluate the prognostic value of Kerdo Index (KI) in patients with aSAH by analyzing its association with clinical outcomes, angiographic vasospasm, cardiac rhythm disturbances, and demographic and comorbid factors. Materials and methods. A retrospective cohort study included 477 patients with aSAH, who were hospitalized between 2000 and 2023 and were stratified according to the Kerdo Index (KI > 0, KI = 0, KI < 0). Clinical outcomes, angiographic vasospasm, ECG abnormalities, hemorrhage type (isolated aSAH, aSAH with intraventricular hemorrhage (IVH), aSAH with intraparenchymal hemorrhage (IPH), aSAH with both IVH and IPH) and demographic and comorbid factors were analyzed using descriptive statistics and logistic regression. Results and discussion. We found that in the group with KI > 0, the number of patients aged 60 to 74 years was significantly lower (p = 0.002), in the group with KI = 0, aSAH was more frequently observed in men, whereas aSAH in the group with KI > 0 was more common in women (p = 0.033). Both KI > 0 (p = 0.021) and KI < 0 were significantly associated with an increased risk of mortality (p = 0.039). We found that KI > 0 was linked to a higher probability of angiographically confirmed vasospasm (p = 0.026), whereas KI was associated with a reduced probability (p = 0.03). An increased risk of ECG abnormalities was observed in patients with both deviations in KI (p < 0.001). No statistically significant differences were found between the groups in WFNS score on admission, treatment type, hemorrhage type, risk of rebleeding, or comorbidities (p > 0.05). Conclusions. In the group with KI > 0, the number of patients aged 60 to 74 years was significantly lower, in the group with KI = 0, aSAH was more frequently observed in men, whereas aSAH in the group with KI > 0 was more common in women. KI deviations were significantly connected to an increase in the risk of ECG abnormalities in patients with aSAH. Both KI > 0 and KI < 0 were significantly associated with an increased risk of mortality. While KI > 0 was linked to a higher probability of angiographically confirmed vasospasm, KI < 0 was associated with a reduced probability. KI may serve as a useful prognostic marker in patients with aSAH.