Background The risk factors of aetiology and poor outcome in angiographically negative subarachnoid haemorrhage (anSAH) were unclearly. Methods The authors performed a retrospective review of a prospectively maintained database for anSAH patients between 2014 and 2018. AnSAH was defined as SAH presents in CT with no underlying vascular abnormality on initial digital subtraction angiography (DSA) within 72 hours of admission. Baseline and follow-up information, including medical history, bleeding pattern (perimesencephalic angiogram-negative SAH (PAN-SAH) and non-PAN-negative SAH (NPAN-SAH)), modified Fisher Scale (mFS), Glasgow Coma Score (GCS), Hunt-Hess grade, repeated imaging and causative vascular lesions and follow-up modified Rankin Scale (mRS) were reviewed. Poor outcome was defined as mRS scored 3–6 at last clinical follow-up. Results Among 303 enrolled patients, 272 patients underwent at least once repeated imaging examination (median follow-up time, 3.0 months). Twenty-one (7.7%) aneurysms were detected. Multivariate logistic analysis showed that NPAN-SAH and mFS 3–4 were associated with a high rate of aneurysm detection in anSAH patients. Based on risk stratification, the aneurysm detection rate in the high-risk group (both NPAN-SAH and mFS 3–4) was as high as 20.370 per 100 person-years. Furthermore, of 251 non-aneurysm anSAH patients, after a total follow-up time of 1265.83 patient-years, poor outcome occurred in 18 (7.2%) patients. Multivariate Cox analysis found that NPAN-SAH and GCS 3–12 were associated with a high rate of poor outcome of anSAH. The cumulative 5-year incidence rate for poor outcome in the non-aneurysm anSAH patients in the high-risk group (both NPAN-SAH and GCS 3–12) was as high as 75.302 per 100 person-years. Conclusions Even in anSAH confirmed by initial DSA, patients with NPAN-SAH and mFS 3–4 should be monitored for delayed causative aneurysm detection, meanwhile in non-aneurysm anSAH patients, NPAN-SAH and initial functional impairment are associated with poor prognosis. Data are available on reasonable request.

中文翻译：

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延迟性动脉瘤检测的风险分层和血管造影阴性自发性蛛网膜下腔出血的长期结果

背景 血管造影阴性蛛网膜下腔出血 (anSAH) 的病因和不良预后的危险因素尚不清楚。方法 作者对 2014 年至 2018 年间 anSAH 患者的前瞻性数据库进行了回顾性审查。AnSAH 的定义是入院 72 小时内 CT 中出现 SAH，且初始数字减影血管造影 (DSA) 没有潜在血管异常。基线和随访信息，包括病史、出血模式（中脑周围血管造影阴性 SAH (PAN-SAH) 和非 PAN 阴性 SAH (NPAN-SAH)）、改良 Fisher 量表 (mFS)、格拉斯哥昏迷评分 (GCS) ）、Hunt-Hess 分级、重复影像学和致病性血管病变以及随访改良 Rankin 量表（mRS）进行了回顾。不良结果定义为上次临床随访时 mRS 评分为 3-6。结果 303 例入组患者中，272 例患者至少接受过一次重复影像学检查（中位随访时间为 3.0 个月）。检测到二十一个 (7.7%) 动脉瘤。多变量逻辑分析表明，NPAN-SAH 和 mFS 3-4 与 anSAH 患者的高动脉瘤检出率相关。根据风险分层，高危组（NPAN-SAH和mFS 3-4）的动脉瘤检出率高达20.370/100人年。此外，在 251 名非动脉瘤 anSAH 患者中，总随访时间为 1265.83 患者年后，18 名 (7.2%) 患者出现不良预后。多变量 Cox 分析发现 NPAN-SAH 和 GCS 3-12 与 anSAH 不良结局的高发生率相关。高危组（NPAN-SAH 和 GCS 3-12）非动脉瘤 anSAH 患者的不良结局累积 5 年发生率高达每 100 人年 75.302 例。结论 即使在初始 DSA 证实的 anSAH 中，NPAN-SAH 和 mFS 3-4 的患者也应进行监测，以发现延迟的致病动脉瘤，同时在非动脉瘤 anSAH 患者中，NPAN-SAH 和初始功能障碍与不良预后相关。可根据合理要求提供数据。