Extracranial organ dysfunction in non-traumatic subarachnoid hemorrhage: a retrospective single center cohort study

Non-traumatic subarachnoid hemorrhage (SAH) is a potentially devastating type of stroke associated with high morbidity and mortality rates. SAH patients are at risk of systemic complications and extracranial organ dysfunction that may worsen their outcome. The objective of this study was to assess the impact of early onset extracranial organ dysfunction on the outcome of SAH patients. We performed a retrospective single center cohort study of consecutive non-traumatic SAH patients admitted to the Intensive Care Unit (ICU) of the Brussels University Hospital (Brussels, Belgium) from January 2012 to December 2022. The modified Sequential Organ Failure Assessment (mSOFA) score, excluding the neurological component, was calculated daily for the first 5 days after ICU admission to assess the presence of extra-cerebral organ dysfunction. Unfavorable Outcome (UO) was defined as a Glasgow Outcome Scale of 1–3 at 3 months. A total of 387 patients were included; mean age was 55 (±13) years and 240 (62%) patients were female. The median World Federation of Neurosurgical Societies score on admission was 3 (IQR 1–5). At 3 months, 189 (48.8%) patients had UO (n= 125 being non-survivors). The median mSOFA on admission was 2 (0–4). The majority of patients (n = 330, 85.3%) experienced at least on extracranial organ dysfunction in the first 5 days of hospitalization, the most common being respiratory (276/387 patients, 71.3%) and cardiovascular (224/387 patients, 57.9%). In a generalized multilevel mixed model, mSOFA in the first 5 days of ICU admission was independently associated with UO (OR 1.29 95% CI 1.21–1.37). In this cohort, early extracranial organ dysfunction assessed by the mSOFA score was common in SAH patients. Higher SOFA score was significantly associated with a higher risk of unfavorable outcome.