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Background <p>Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition with high morbidity and mortality, particularly in poor-grade patients (World Federation of Neurosurgical Societies grades IV–V). Intraventricular hemorrhage (IVH) is associated with worse outcomes, but its predictive value and interaction with demographic and clinical factors remain unclear.</p> Purpose <p>To evaluate the prognostic value of IVH volume (IVHV) quantified on admission computed tomography (CT) in association with mortality and long-term disability, as well as its interaction with demographic and clinical variables in patients with poor-grade aSAH.</p> Methods <p>We retrospectively analyzed all consecutive patients with poor-grade aSAH and IVH that were admitted to nine Italian tertiary centers between 1 January 2015 and 31 May 2023. Bivariate and multivariable analyses were performed to identify factors associated with mortality and disability (modified Rankin Scale [mRS]). Global intracranial hemorrhage volume (GHV) as well as the volumes of ICH (ICHV), IVH (IVHV), and SAH (SAHV) were calculated by means of analytical software in a semiautomated setting. We employed an explainable machine learning approach to examine the interplay between hemorrhage volume distribution, demographic and clinical variables to define prognostic thresholds, and to develop a decision tree model.</p> Results <p>Among 326 patients with IVH (median age 61&#xa0;years [IQR: 53–70], 65.6% male), IVHV was the strongest factor independently associated with mortality and disability. An IVHV threshold of 8&#xa0;mL optimized sensitivity and specificity for the outcome. Combining IVHV with age and ICHV further improved prognostic thresholds in the studied population; specificity was 92% for mortality and 71% sensitivity for disability. Adding IVHV to the SAFIRE scale significantly improved its predictive power (De Long p .008).</p> Conclusions <p>IVHV is a key factor associated with mortality and disability in poor-grade aSAH with intraventricular involvement. Quantifying hemorrhage volume on admission CT is a valuable tool for improving outcome stratification and guiding clinical decision-making.</p>

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CT Quantification of Intraventricular Hemorrhage Volume in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Impact on Mortality and Long-Term Disability

  • 期刊论文

  • 发表日期：

    2026年6月24日

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  • Gianfranco Vornetti,
  • Carlo Bortolotti,
  • Massimo Dall’Olio,
  • Raffaele Aspide,
  • Luigi Cirillo,
  • Mohammed O. Alalfi,
  • Caterina Tonon,
  • Raffaele Lodi,
  • Alessandro Pedicelli,
  • Enrico Marchese,
  • Anselmo Caricato,
  • Andrea Alexandre,
  • Nicolò Mandruzzato,
  • Alberto Feletti,
  • Mattia Testa,
  • Paolo Zanatta,
  • Nicola Gitti,
  • Simone Piva,
  • Dikran Mardighian,
  • Vittorio Semeraro,
  • Giordano Nardin,
  • Edoardo Picetti,
  • Vito Montanaro,
  • Massimo Petranca,
  • Emilio Lozupone,
  • Gianfranco Paiano,
  • Andrea Luigi Lanterna,
  • Rosanna Vaschetto,
  • Carmelo Stanca,
  • Christian Cossandi,
  • Luca Bucciardini,
  • Nicola Limbucci,
  • Serena Tola,
  • Alessandro Ambrosi,
  • Maria Rosa Calvi,
  • Maria Luisa Azzolini,
  • Roberta Cao,
  • Pietro Mortini,
  • Andrea Falini,
  • Pietro Panni

摘要

Background

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition with high morbidity and mortality, particularly in poor-grade patients (World Federation of Neurosurgical Societies grades IV–V). Intraventricular hemorrhage (IVH) is associated with worse outcomes, but its predictive value and interaction with demographic and clinical factors remain unclear.

Purpose

To evaluate the prognostic value of IVH volume (IVHV) quantified on admission computed tomography (CT) in association with mortality and long-term disability, as well as its interaction with demographic and clinical variables in patients with poor-grade aSAH.

Methods

We retrospectively analyzed all consecutive patients with poor-grade aSAH and IVH that were admitted to nine Italian tertiary centers between 1 January 2015 and 31 May 2023. Bivariate and multivariable analyses were performed to identify factors associated with mortality and disability (modified Rankin Scale [mRS]). Global intracranial hemorrhage volume (GHV) as well as the volumes of ICH (ICHV), IVH (IVHV), and SAH (SAHV) were calculated by means of analytical software in a semiautomated setting. We employed an explainable machine learning approach to examine the interplay between hemorrhage volume distribution, demographic and clinical variables to define prognostic thresholds, and to develop a decision tree model.

Results

Among 326 patients with IVH (median age 61 years [IQR: 53–70], 65.6% male), IVHV was the strongest factor independently associated with mortality and disability. An IVHV threshold of 8 mL optimized sensitivity and specificity for the outcome. Combining IVHV with age and ICHV further improved prognostic thresholds in the studied population; specificity was 92% for mortality and 71% sensitivity for disability. Adding IVHV to the SAFIRE scale significantly improved its predictive power (De Long p .008).

Conclusions

IVHV is a key factor associated with mortality and disability in poor-grade aSAH with intraventricular involvement. Quantifying hemorrhage volume on admission CT is a valuable tool for improving outcome stratification and guiding clinical decision-making.