The association of findings on brain computed tomography with neurologic outcomes in patients with poor-grade subarachnoid hemorrhage

Objective: We evaluated if the optic nerve sheath diameter (ONSD) and computed tomography (CT) grading scale on brain CT could be used to predict neurological outcomes of patients with poor-grade subarachnoid hemorrhage (SAH). Methods: This was a retrospective, multicenter, observational study of adult patients with poor-grade SAH admitted January 2012 through June 2017. Initial brain CT was performed within 12 h from the onset of SAH, and follow-up brain CT was performed within 24 h from the treatment of ruptured aneurysm. The primary outcome was neurological status at six-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). Results: Among 96 patients with poor-grade SAH, survival to discharge was identified in 78 (81.3%) patients. Of these 78 survivors, 63 (65.6%) had good neurological outcomes (GOS of 3, 4 or 5). In this study, initial ONSDs and follow-up ONSDs in the poor neurological outcome group were significantly greater than those in the good neurological outcome group (all p ≤ 0.003). A linear correlation existed between the average ONSD and ICP in simple correlation analysis (ρ = 0.719, P = 0.001). The ROC curve analysis for prediction of poor neurological outcome showed that ONSD had considerable predictive value (C-statistics: 0.684 to 0.798). In addition, the performance of a composite of Fisher grade and ONSD was increasingly associated with poor neurological outcomes than the use of either marker alone. Multivariable logistic regression analysis revealed that age (adjusted odd ratio [OR] 1.04, 95% confidence interval [CI] 1.001 – 1.071), Fisher grade (adjusted OR 16.10, 95% CI 2.965 – 87.483) and follow-up ONSD (adjusted OR 15.25, 95% CI 3.522 – 66.061) were significantly associated with poor neurological outcomes of SAH patients. Conclusions: The ONSDs and Fisher CT grading scale measured on CT scanning may be used to predict neurological outcomes of patients with poor-grade SAH.