Short term outcomes following clipping and coiling of ruptured intracranial aneurysms: does some of the benefit of coiling stem from less procedural impact on deranged physiology at presentation?

2014 ◽  
Vol 8 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Alex M Mortimer ◽  
Celia Bradford ◽  
Brendan Steinfort ◽  
Ken Faulder ◽  
Nazih Assaad ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Strong Predictor ◽  
Cerebral Aneurysms ◽  
Binary Logistic Regression ◽  
Apache Ii ◽  
Endovascular Coiling ◽  
Apache Ii Score ◽  
World Federation ◽  
Poor Outcome ◽  
Norepinephrine Dose

BackgroundEndovascular coiling (EVC) has been shown to yield superior clinical outcomes to surgical clipping (SC) in the treatment of ruptured cerebral aneurysms. The reasons for these differences remain obscure. We aimed to assess outcomes of EVC and SC relative to baseline physiological derangement.MethodsThis was an exploratory analysis of prospectively collected trial data. Physiological derangement was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. Other contributory variables such as age, World Federation of Neurosurgical Societies (WFNS) grade, and development of complications, including hydrocephalus and vasospasm, were included in the analysis. Clinical outcome was independently assessed at 90 days using the modified Rankin Scale (mRS). Hospital stay, ventilated days, and total norepinephrine dose were also used as secondary outcomes. Multivariate analysis was performed using binary logistic regression.ResultsEVC was performed in 69 patients and SC in 66 patients. More profound physiological derangement (APACHE II score >15) was the strongest predictor of poor outcome in the overall cohort (OR 17.80, 95% CI 4.78 to 66.21, p<0.0001). For those with more deranged physiology (APACHE II score>15; 59 patients), WFNS grade ≥4 (OR 6.74, 1.43 to 31.75) and SC (OR 6.33, 1.27 to 31.38) were significant predictors of poor outcome (p<0.05). Favorable outcome (mRS 0–2) was seen in 11% of SC patients compared with 38% of EVC patients in this subgroup. SC patients had significantly increased total norepinephrine dose, ventilated days, and hospital stay (p<0.05).ConclusionsMore profound physiological derangement at baseline is a strong predictor of eventual poor outcome, and outcomes for patients with more profound baseline physiological derangement may be improved if undergoing a coiling procedure.

scholarly journals Predicting Burn Mortality Using a Simple Novel Prediction Model

2021 ◽  
Author(s):  
Sneha Sharma ◽  
Raman Tandon
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Prediction Model ◽  
Receiver Operating Characteristic ◽  
Logistic Regression Analysis ◽  
Operating Characteristic ◽  
Binary Logistic Regression ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Binary Logistic Regression Analysis

Abstract Background Prediction of outcome for burn patients allows appropriate allocation of resources and prognostication. There is a paucity of simple to use burn-specific mortality prediction models which consider both endogenous and exogenous factors. Our objective was to create such a model. Methods A prospective observational study was performed on consecutive eligible consenting burns patients. Demographic data, total burn surface area (TBSA), results of complete blood count, kidney function test, and arterial blood gas analysis were collected. The quantitative variables were compared using the unpaired student t-test/nonparametric Mann Whitney U-test. Qualitative variables were compared using the ⊠2-test/Fischer exact test. Binary logistic regression analysis was done and a logit score was derived and simplified. The discrimination of these models was tested using the receiver operating characteristic curve; calibration was checked using the Hosmer—Lemeshow goodness of fit statistic, and the probability of death calculated. Validation was done using the bootstrapping technique in 5,000 samples. A p-value of <0.05 was considered significant. Results On univariate analysis TBSA (p <0.001) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p = 0.004) were found to be independent predictors of mortality. TBSA (odds ratio [OR] 1.094, 95% confidence interval [CI] 1.037–1.155, p = 0.001) and APACHE II (OR 1.166, 95% CI 1.034–1.313, p = 0.012) retained significance on binary logistic regression analysis. The prediction model devised performed well (area under the receiver operating characteristic 0.778, 95% CI 0.681–0.875). Conclusion The prediction of mortality can be done accurately at the bedside using TBSA and APACHE II score.

scholarly journals Early serum miR-1297 is an indicator of poor neurological outcome in patients with aSAH

2018 ◽  
Vol 38 (6) ◽  
Author(s):  
Bin Sheng ◽  
Nian-sheng Lai ◽  
Yang Yao ◽  
Jin Dong ◽  
Zhen-bao Li ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multivariate Logistic Regression Analysis ◽  
Endovascular Coiling ◽  
World Federation ◽  
Healthy Controls ◽  
Fisher Score ◽  
Independent Predictive Factor ◽  
Time Points ◽  
Poor Outcome

Objective: MiRNAs are important regulators of translation and have been described as biomarkers of a number of cardiovascular diseases, including stroke. The purpose of the study was to determine expression levels of serum miR-1297 in patients with aneurysmal subarachnoid hemorrhage (aSAH), and to assess whether miR-1297 was the prognostic indicator of aSAH. Methods: We treated 128 aSAH patients with endovascular coiling. The World Federation of Neurological Surgeons (WFNS) grades, Hunt–Hess grades, and modified Fisher scores were used to assess aSAH severity. Neurologic outcome was assessed using the Modified Rankin Scale (mRS) at 1-year post-aSAH. Serum was taken at various time points (24, 72, and 168 h, and 14 days). Serum samples from aSAH patients and healthy controls were subjected to reverse transcription (RT) quantitative real-time PCR (RT-qPCR). Results: A poor outcome at 1 year was associated with significantly higher levels of miR-1297 value at the four time points, higher WFNS grade, higher Hunt–Hess grade, and higher Fisher score. Serum miR-1297 levels were significantly higher in patients, compared with healthy controls. There were significant correlations of miR-1297 concentrations in serum with severity in aSAH. The AUCs of miR-1297 at the four time points for distinguishing the aSAH patients from healthy controls were 0.80, 0.94, 0.77, and 0.59, respectively. After multivariate logistic regression analysis, only miR-1297 at 24 and 72 h enabled prediction of neurological outcome at 1 year. Conclusion: Serum was an independent predictive factor of poor outcome at 1 year following aSAH. This result supports the use of miR-1297 in aSAH to aid determination of prognosis.

A COMPARATIVE STUDY OF TWO SURGICALAPPROACHES – PRIMARY CLOSURE AND RESECTION ANASTOMOSIS IN ENTERIC ILEAL PERFORATION PERITONITIS IN APACHE GROUP B PATIENTS

2021 ◽  
pp. 48-50
Author(s):  
Rajeev Kumar Singh ◽  
Akash Singh ◽  
Prateek Shakya
Keyword(s):  
Gastrointestinal Tract ◽  
Hospital Stay ◽  
Primary Closure ◽  
Primary Repair ◽  
Anastomosis Group ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Group I ◽  
Perforation Peritonitis ◽  
Repair Group

INTRODUCTION - Perforation peritonitis is the most common surgical emergency in India. The spectrum of etiology of perforation in tropical countries continues to be different from its western counterpart. In contrast to western literature, where lower gastrointestinal tract perforations predominate, upper gastrointestinal tract perforations constitute the majority of cases in India and the Indian subcontinent. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, management of peritonitis continues to be highly demanding, difcult and complex. METHODS - Patients with APACHE II score between10-19 were selected for this study and blindly randomized into two procedure i.e., primary closure and resection-anastomosis. The patients in study group were subjected to detailed history, complete general physical examination and selection of patients into groups by acute physiology and chronic health evaluation (APACHE II) scoring. Post-operative outcome was assessed by number of days after which patient pass atus and stool, number of days of post-operative antibiotics requirement, duration of hospital stay, postoperative complications and mortality/morbidity. RESULTS - In the present study male preponderance was found with male to female ratio of 5.4:1. Widal test positivity in our study was 95.56%. About 68.88% of patient presented within 48 hours of perforation and had favorable outcome from those who presented late. In our study different operative procedures – simple closure of perforation and resection- anastomosis were performed alternatively with 45 patients in each group. Wound infection was the most common post-operative complication - 13.33% (n=6) in Group I and 28.89% (n=13) in Group II (P=0.071). Most common systemic complication encountered was pleural effusion (23.33%; n=21). In primary repair group, it was seen in 8 cases (17.8%) and in resection-anastomosis group, it was seen in 13 cases (28.9%). Other systemic complications observed were pneumonia, sepsis and renal failure. Mean length of hospital stay in primary repair group was days and in resection-anastomosis group was days. CONCLUSION - Primary closure of perforation was advocated in patients with single, small perforation (<1cm) with APACHE II score 10-19 irrespective of duration of perforation. Resection-anastomosis is advocated in multiple perforations, diseased segment of bowel. The two procedures were found to be similar in terms of morbidity and mortality. The nal decision can be made based on surgeon's discretion.

scholarly journals Tree-Based Models for Predicting Mortality in Gram-Negative Bacteremia: Avoid Putting the CART before the Horse

2015 ◽  
Vol 60 (2) ◽  
pp. 838-844 ◽  
Author(s):  
Nathaniel J. Rhodes ◽  
J. Nicholas O'Donnell ◽  
Bryan D. Lizza ◽  
Milena M. McLaughlin ◽  
John S. Esterly ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Regression Tree ◽  
Binary Logistic Regression ◽  
Predictive Performance ◽  
Threshold Value ◽  
Apache Ii ◽  
Classification And Regression Tree ◽  
Apache Ii Score ◽  
Receiver Operating Characteristic Curves ◽  
Gram Negative Bacteremia

ABSTRACTIncreasingly, infectious disease studies employ tree-based approaches, e.g., classification and regression tree modeling, to identify clinical thresholds. We present tree-based-model-derived thresholds along with their measures of uncertainty. We explored individual and pooled clinical cohorts of bacteremic patients to identify modified acute physiology and chronic health evaluation (II) (m-APACHE-II) score mortality thresholds using a tree-based approach. Predictive performance measures for each candidate threshold were calculated. Candidate thresholds were examined according to binary logistic regression probabilities of the primary outcome, correct classification predictive matrices, and receiver operating characteristic curves. Three individual cohorts comprising a total of 235 patients were studied. Within the pooled cohort, the mean (± standard deviation) m-APACHE-II score was 13.6 ± 5.3, with an in-hospital mortality of 16.6%. The probability of death was greater at higher m-APACHE II scores in only one of three cohorts (odds ratio for cohort 1 [OR1] = 1.15, 95% confidence interval [CI] = 0.99 to 1.34; OR2= 1.04, 95% CI = 0.94 to 1.16; OR3= 1.18, 95% CI = 1.02 to 1.38) and was greater at higher scores within the pooled cohort (OR4= 1.11, 95% CI = 1.04 to 1.19). In contrast, tree-based models overcame power constraints and identified m-APACHE-II thresholds for mortality in two of three cohorts (P= 0.02, 0.1, and 0.008) and the pooled cohort (P= 0.001). Predictive performance at each threshold was highly variable among cohorts. The selection of any one predictive threshold value resulted in fixed sensitivity and specificity. Tree-based models increased power and identified threshold values from continuous predictor variables; however, sample size and data distributions influenced the identified thresholds. The provision of predictive matrices or graphical displays of predicted probabilities within infectious disease studies can improve the interpretation of tree-based model-derived thresholds.

Visualisation of the non-linear correlation between age and poor outcome in patients with aneurysmal subarachnoid haemorrhage

2021 ◽  
pp. jnnp-2020-325306
Author(s):  
Fusao Ikawa ◽  
Nao Ichihara ◽  
Masaaki Uno ◽  
Yoshiaki Shiokawa ◽  
Kazunori Toyoda ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Linear Correlation ◽  
Clinical Decision Making ◽  
Variable Importance ◽  
Additive Models ◽  
Endovascular Coiling ◽  
World Federation ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Poor Outcome ◽  
Non Linear

ObjectiveTo visualise the non-linear correlation between age and poor outcome at discharge in patients with aneurysmal subarachnoid haemorrhage (SAH) while adjusting for covariates, and to address the heterogeneity of this correlation depending on disease severity by a registry-based design.MethodsWe extracted data from the Japanese Stroke Databank registry for patients with SAH treated via surgical clipping or endovascular coiling within 3 days of SAH onset between 2000 and 2017. Poor outcome was defined as a modified Rankin Scale Score ≥3 at discharge. Variable importance was calculated using machine learning (random forest) model. Correlations between age and poor outcome while adjusting for covariates were determined using generalised additive models in which spline-transformed age was fit to each neurological grade of World Federation of Neurological Societies (WFNS) and treatment.ResultsIn total, 4149 patients were included in the analysis. WFNS grade and age had the largest and second largest variable importance in predicting the outcome. The non-linear correlation between age and poor outcome was visualised after adjusting for other covariates. For grades I–III, the risk slope for unit age was relatively smaller at younger ages and larger at older ages; for grade IV, the slope was steep even in younger ages; while for grade V, it was relatively smooth, but with high risk even at younger ages.ConclusionsThe clear visualisation of the non-linear correlation between age and poor outcome in this study can aid clinical decision making and help inform patients with aneurysmal SAH and their families better.

Factors Predicting the Outcome of the Blood and Marrow Transplant Patients Admitted to Intensive Care Unit.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3340-3340
Author(s):  
Nalini K Pati ◽  
Biju George ◽  
Ian Kerridge ◽  
Nicole Gilroy ◽  
Vineet Nayyar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Organ Failure ◽  
Apache Ii ◽  
Haematopoietic Stem Cell ◽  
Apache Ii Score ◽  
Allogeneic Hsct ◽  
Icu Admission ◽  
Poor Outcome ◽  
Organ Failures ◽  
Steroid Refractory

Abstract Abstract 3340 Poster Board III-228 Aim: To identify factors predicting outcome of patients admitted to intensive care (ICU) following allogeneic haematopoietic stem cell transplantation (allo-HSCT). Methods: Retrospective audit of all allo-HSCT patients requiring ICU admission. Results: Between 2000 and 2009, 392 patients underwent allo-HSCT. Of these, 106 (27%) had 129 ICU admissions. The median age was 47 (range 16-65) with myeloablative transplant in 89 and reduced intensity in 40 patients. Respiratory failure was the main reason for admission (54.6%) followed by sepsis (41.5%). During the period of ICU admission, 29.2% demonstrated improvement in organ failures, 39.2% remained stable and 28.4% deteriorated. Sixty-seven patients (51.9%) were discharged from ICU but only 48 (37%) were subsequently discharged from the hospital (ICU). Univariate analysis identified ICU admission within 30 days post HSCT, number of organ failures at admission, progression of organ failure during ICU admission, APACHE II score at admission, steroid refractory GVHD, and requirement for inotropic support or dialysis as significant predictors for survival in ICU. Patients requiring intubation and mechanical ventilation had a poorer outcome than the group who did not (84.4% Vs 20.0%, p=0.001). Those who required only non-invasive ventilation generally had a good outcome with 84.4% surviving til ICU discharge. While bacterial infection prior to ICU admission did not alter the outcome (p=0.221), the onset of a new infection in ICU was associated with a poor outcome (p=0.0001). Logistic regression analysis identified steroid refractory GvHD (P=0.027; 95% CI of 1.17-14.8), APACHE II score > 30 (p=0.003; 95% CI 1.5-10.5), admission <30 days post HSCT (p = 0.015; 95% CI 0.12-0.8), requirement of invasive ventilatory support (p = 0.005, 95% CI 2.58 – 223.83) and dialysis (p = 0.011; 95%CI 1.401 – 13.20) as significant factors for a poor outcome. Conclusion: More than 50% of patients admitted to ICU following allogeneic HSCT survive. A high APACHE II score, steroid refractory GVHD, admission into ICU within 30 days of HSCT, multiorgan failure, progression of organ failure during ICU stay, and the need for ventilation or dialysis, carries a dismal prognosis. Identification of risk factors associated with a poor outcome will assist in clinical management and may ultimately improve the outcome of patients requiring ICU admission following allogeneic HSCT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Apache II score in predicting surgical outcome in patients of secondary peritonitis: a prospective and observational study

2020 ◽  
Vol 8 (4) ◽  
pp. 1505
Author(s):  
Shaukat Jeelani ◽  
Asgar Aziz ◽  
Irshad A. Kumar ◽  
Waseem A. Dar ◽  
Farzanah Nowreen
Keyword(s):  
Hospital Stay ◽  
Abdominal Cavity ◽  
Scoring Systems ◽  
Strong Relationship ◽  
Systemic Effect ◽  
Secondary Peritonitis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
The Mean ◽  
The Government

Background: Peritonitis is defined as inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. Secondary peritonitis presenting as acute generalized peritonitis is a common surgical emergency often associated with significant morbidity and mortality. Many scoring systems have been found useful in predicting the outcome in critically ill patients, thus allowing application of resources for effective use. Amongst them acute physiology and chronic health evaluation score (APACHE II), have a strong relationship to the outcome than previous groupings without consideration for systemic effect of the intra-abdominal sepsis.Methods: This study was conducted in the Department of General surgery, Sri Maharaja Hari Singh (SMHS) Hospital an associated hospital with the Government Medical College Srinagar, J&K, India. The prospective study was conducted over a period from October 2016 to September 2018 (Two Year) on 108 patients diagnosed with secondary peritonitis. Data was collected and analysed using SPSS v 20.Results: study included 108 patients with males involving 74.1% (80). The mean age of our study was 34 yr. (2-88 yr.), and 21-40 yr. (44.5%) group was mostly involved. Pain abdomen was present in 100% patients followed by nausea/vomiting (88%). Higher the APACHE VII score higher were post-operative complications (31+ score group 100%), mortality (31+ score group 100%) and less hospital stay (31+ score group 1.5 days) due to increased mortality.Conclusions: APACHE II score correlated well with postoperative complications, outcome, hospital stay. However, in patients with very high Apache score more than 30, the mean duration of hospital stay is less due to associated increased mortality during early Hospital stay.

scholarly journals Neutrophil-lymphocyte and hematocrit scoring in acute pancreatitis as an early predictor of severity and outcome

2020 ◽  
Vol 7 (7) ◽  
pp. 2251
Author(s):  
Satish Kumar R. ◽  
Sharath A. ◽  
Prajwal R. K. ◽  
Supreeth K.
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Adverse Outcomes ◽  
Apache Ii ◽  
Initial Time ◽  
Apache Ii Score ◽  
Neutrophil Lymphocyte Ratio ◽  
Tertiary Center ◽  
Severe Group

Background: The management of acute pancreatitis (AP) is determined by an accurate assessment of severity of disease. Numerous severity indicators have been described till date, most of which require reassessment after admission and resuscitation. Authors propose a novel indicator, the neutrophil-lymphocyte and hematocrit (NLH) scoring as a predictor of acute pancreatitis at the initial time of diagnosis. NLH may have a role in predicting the length of hospital stay and intensive care unit admission and also to predict adverse manifestations of severe acute pancreatitis (SAP).Methods: A retrospective analysis of 107 patients done who diagnosed with acute pancreatitis based on Atlanta 2012 definitions, who were admitted and treated between August 2018 and November 2019. NLH score calculated by adding NLR (neutrophil lymphocyte ratio) and Ht (hematocrit) i.e., NLH=NLR+Ht. NLH was also compared with APACHE II score as a standard predictor of prognosis in acute pancreatitis.Results: Median NLH score among the severe group is significantly higher compared to mild and moderate group. NLH score significantly correlated with length of hospital stay and also had a statistically significant correlation with ICU stay. NLH scoring is comparable with APACHE II scoring system in predicting prognosis in acute pancreatitis.Conclusions: NLH score can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis. Further it may predict adverse outcomes, need for ICU care as well as the length of hospital stay. NLH score can be used as a tool to refer at risk patients to tertiary center needing ICU admission.

scholarly journals Ocular Fundus Abnormalities in Acute Subarachnoid Hemorrhage: The FOTO-ICU Study

Neurosurgery ◽  
2020 ◽  
Author(s):  
Rahul A Sharma ◽  
Philip S Garza ◽  
Valérie Biousse ◽  
Owen B Samuels ◽  
Nancy J Newman ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Logistic Models ◽  
Apache Ii ◽  
Fundus Photography ◽  
Apache Ii Score ◽  
Ocular Fundus ◽  
Poor Outcome ◽  
Lengths Of Stay ◽  
Intraocular Hemorrhage ◽  
Acute Subarachnoid Hemorrhage

ABSTRACT BACKGROUND Ocular fundus abnormalities, especially intraocular hemorrhage, may represent a clinically useful prognostic marker in patients with acute subarachnoid hemorrhage (SAH). OBJECTIVE To evaluate associations between ocular fundus abnormalities and clinical outcomes in acute SAH. METHODS Prospective evaluation of acute SAH patients with ocular fundus photography at bedside. Multivariable logistic models were used to evaluate associations between fundus abnormalities and poor outcome (inpatient death, care withdrawal, or discharge Glasgow Outcome Score &lt;4) and intensive care unit (ICU) and hospital lengths-of-stay, controlling for APACHE II score, respiratory failure at ICU admission, Hunt & Hess score, aneurysmal etiology, age, and sex. RESULTS Fundus abnormalities were present in 29/79 patients with acute SAH (35.4%), and 20/79 (25.3%) had intraocular hemorrhage. In univariate analyses, poor outcomes were more likely among patients with fundus abnormalities vs without (15/28 [53.6%] vs 15/51 [29.4%], P = .03); median length of ICU stay was longer in patients with intraocular hemorrhage than without (18 d [interquartile range (IQR) 12-25] vs 11 [IQR 7-17], P = .03). Logistic regression with fundus abnormality as predictor of interest showed that male sex (odds ratio [OR] 5.33 [95% CI 1.09-26.0], P = .045), higher APACHE II (OR, per 1-point increase, 1.35 [95% CI 1.08-1.78], P = .01), and aneurysmal etiology (OR 4.35 [95% CI 1.01-22.9], P = .048), but not fundus abnormalities (OR 1.56 [95% CI 0.43-5.65], P = .49) or intraocular hemorrhage (OR 1.28 [95% CI 0.26-5.59], P = .75) were associated with poor outcome. CONCLUSION Although ocular fundus abnormalities are associated with disease severity in SAH, they do not add value to patients’ acute management beyond other risk factors already in use.

scholarly journals Association of plasma D-dimer level with thromboembolic events after endovascular coil treatment of ruptured cerebral aneurysms

2019 ◽  
Vol 130 (2) ◽  
pp. 509-516 ◽  
Author(s):  
Hitoshi Fukuda ◽  
Akira Handa ◽  
Masaomi Koyanagi ◽  
Benjamin Lo ◽  
Sen Yamagata
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
World Federation ◽  
Thromboembolic Events ◽  
Chi Square ◽  
Factors Associated ◽  
Ruptured Aneurysms ◽  
Ischemic Complications ◽  
Large Aneurysm ◽  
D Dimer

OBJECTIVEAlthough endovascular therapy is favored for acutely ruptured intracranial aneurysms, hematological factors associated with acute subarachnoid hemorrhage (SAH) may predispose to procedure-related ischemic complications. The aim of this study was to evaluate whether an elevated level of plasma D-dimer, a parameter of hypercoagulation in patients with acute SAH, is correlated with increased incidence of thromboembolic events during endovascular coiling of ruptured aneurysms.METHODSThe authors analyzed data from 103 cases of acutely ruptured aneurysms (in 103 patients) treated with endovascular coil embolization at a single institution. Factors associated with elevated D-dimer level on admission were identified. The authors also evaluated whether D-dimer elevation was independently correlated with increased incidence of perioperative thromboembolic events.RESULTSAn elevated D-dimer concentration (≥ 1.0 μg/ml) on admission was observed in 70 (68.0%) of 103 patients. Increasing age (p < 0.001, Student t-test) and poor initial neurological grade representing World Federation of Neurosurgical Societies (WFNS) grade IV or V (p = 0.0018, chi-square test) were significantly associated with D-dimer elevation. Symptomatic thromboembolic events occurred in 11 cases (10.7%). Elevated D-dimer levels on admission (OR 1.34, 95% CI 1.10–1.62, p = 0.0029) independently carried a higher risk of thromboembolic events after adjustment for potential angiographic confounders, including wide neck of the aneurysm and large aneurysm size.CONCLUSIONSElevated D-dimer levels on admission of patients with acute SAH were significantly associated with increased incidence of thromboembolic events during endovascular coiling of ruptured aneurysms.

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