Editorial Comment—Prehemorrhage Risk Factors for Fatal Intracranial Aneurysm Rupture
Bibliographic record
Abstract
Background and Purpose-The goal of this study was to investigate predictive preictal risk factors for fatal subarachnoid hemorrhage (SAH) in a patient population with verified intracranial aneurysms without surgical selection of patients and with complete follow-up.Methods-A total of 142 patients with 181 unruptured aneurysms diagnosed between 1956 and 1978 were followed up for a total of 2577 person-years until death, SAH, or the years 1997 to 2000.The predictive value of several factors known before SAH was tested for case fatality.Results-During follow-up, 34 first episodes of hemorrhage from a previously verified unruptured aneurysm occurred.Of these bleeding episodes, 17 were fatal.Patients who died after the bleeding had higher blood pressure values (meanϮSD, 148Ϯ11/92Ϯ8 mm Hg; mean pressure, 111Ϯ9 mm Hg) before hemorrhage than did those with nonfatal bleeding (meanϮSD, 135Ϯ15/83Ϯ11 mm Hg; mean, 101Ϯ12 mm Hg) (PϽ0.05).Patients with fatal SAH were also older (54Ϯ7 versus 47Ϯ13 years, Pϭ0.068) and had aneurysms larger in diameter (13Ϯ8 versus 10Ϯ5 mm) than those who survived.They had a higher prevalence of definite hypertension (56% versus 12%, PϽ0.05), more frequently used antihypertensive medication (29% versus 6%) by the end of follow-up, and tended to have higher blood pressure at the beginning of follow-up (140Ϯ21/85Ϯ11 versus 134Ϯ17/80Ϯ9 mm Hg).After adjustment for age, aneurysm size, and sex, the only indisputable significant independent risk factor for fatal SAH compared with nonfatal SAH was systolic blood pressure before aneurysm rupture (odds ratio, 1.11 per 1 mm Hg; 95% CI, 1.01 to 1.23; Pϭ0.032).The adjusted odds ratio of definite hypertension for fatal SAH was 12.67 (95% CI, 1.53 to 104.70; Pϭ0.018).Conclusions-Increased systolic blood pressure values and long-term hypertension before aneurysm rupture seem to predict fatal SAH independently of aneurysm size or patient age or sex at the time of rupture.(Stroke.2003;34:1852-1858.)Key Words: hypertension Ⅲ intracranial aneurysm Ⅲ natural history Ⅲ outcome Ⅲ subarachnoid hemorrhageA neurysmal subarachnoid hemorrhage (SAH), despite improvements in surgical and medical treatment, is a serious disease with high rates of mortality (40% to 50%) and morbidity.1,2 Outcome of SAH is still determined mainly by severity of initial bleed or early rebleeding 1-3 and, to a lesser extent, by delayed cerebral ischemia, commonly attributed to vasospasm in the large cerebral arteries.4 -6 Hence, identification of modifiable risk factors for SAH and for impaired outcome after the bleeding is important as a means to influence incidence and outcome of this serious disease.Indisputable modifiable risk factors for SAH seem to be cigarette smoking, alcohol consumption, and hypertension.[7][8][9][10] Besides severity of bleeding, outcome after SAH may be influenced by such preictal factors as patient age, 4,11-13 aneurysm site 4 and size (in surgical SAH cases), 4 history of hypertension, 11,13 and heavy alcohol drinking.11 Patient age, 4,12 aneurysm site, 4 and recent history of heavy alcohol consumption 11 (which is correlated with hypertension) have been reported independently of severity of SAH to
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.030 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.003 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.024 | 0.021 |
| Insufficient payload (model declined to judge) | 0.013 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".