IMPACT OF BIOCHEMICAL AND PSYCHOLOGICAL MARKERS OF STRESS ON OUTCOME OF SUBARACHNOID HAEMORRHAGE PATIENTS: A PROSPECTIVE STUDY.

Dr. Sri Krishna Majhi, Rahul Ahluwalia, Dr. Anup Kumar Choudhuri

Abstract


Observations & Results: A total of 156 patients were included. Mean age being 50 years for spontaneous SAH and 35
years for traumatic SAH. Median GCS was 15 amongst 71.2% with aSAH compared to 62.9% with tSAH, while no
patient with a SAH had GCS<9, 9.28% cases with tSAH had GCS<9 (p value=0.029). Neurodecit was seen in 16.95% of aSAH compared to
only 8.25% in tSAH (p value=0.01).WFNS grade 4 was seen in 1.69% of aSAH cases compared to 15.46% of tSAH (p=0.03). Type D personality
was seen in 44.45% of aSAH patients compared to 38.46% of tSAH patients (p=0.1). PSLES evaluation showed severe stress in 21.05% of aSAH
cases compared to 25.27% of tSAH cases (p=0.029). Serum cortisol levels were signicantly higher in patients with SAH compared to matched
controls (median [IQR]:36.0[23.7- 39.3]vs.14.0 [9.8-17.6] μmol/L, p value < 0.001), whereas serum CRP levels in SAH had statistically nonsigni
cant higher range (median [IQR]: 2.1 [1.0-6.2] vs. 2.2 [0.8- 4.4] mg/L, p value = 0.23). Microalbuminuria was signicantly higher in
patients with delayed neurological decits (p = 0.026) and lower triglyceride levels were signicantly associated with higher risk of vasospasm (p
=0.004). Death was seen in a total of 11 aSAH patients and 28 tSAH cases. No signicant difference was seen in mortality amongst the two groups
with a compiled mortality of 39 patients (p = 0.614).
Conclusion: Stress and inammation play key role in SAH and its outcome. To ensure safe outcome of patients, biochemical stress and
inammation need to be adequately controlled.


Keywords


SAH; stress; aneurysm

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