Predictive value of plasma fibrinogen levels for outcome of aneurysmal subarachnoid haemorrhage during the first week of illness

Objectives
Aneurysmal subarachnoid haemorrhage (SAH) is an acute cerebrovascular event characterised by the rupture of an aneurysm within the subarachnoid space. Secondary injuries increase both mortality and morbidity in patients who survive the primary haemorrhage. Inflammation and coagulation play critical roles in the pathophysiology of SAH. Fibrinogen is involved in both, yet despite wide availability, its prognostic value in aneurysmal SAH is not clear.

Material and methods
A prospectively collected database of 97 aneurysmal SAH patients was reviewed for plasma fibrinogen level results. All patients admitted within 24 hours of aneurysm rupture and treated endovascularly within 48 hours were included. The outcome was assessed at three months according to the Glasgow Outcome Scale (GOS). Correlation with the outcome and analysis for patients’ death and unfavourable outcome were performed.

Results
Fibrinogen level on day 2 significantly correlates with GOS at 3 months. The analysis for mortality revealed that high levels of fibrinogen on days 1, 2 and 3-4 were significant, but not independent predictors for mortality. Univariate analysis for unfavourable outcome indicated no significant prognostic value of fibrinogen levels. Statistically significant elevation of fibrinogen level was found on day 2 in patients with an intraventricular haematoma (p < 0.01). We also noted that fibrinogen level was elevated in patients with a Glasgow Coma Scale score less than 13 (p = 0.013).

Conclusions
Fibrinogen level might serve as an accessory prognostic tool for patients’ death. Fibrinogen level was significantly elevated in patients with intraventricular haematoma and in patients with a poor clinical condition on admission.