Clusters Across Multiple Domains of Health-Related Quality of Life Reveal Complex Patient Outcomes After Subarachnoid Hemorrhage. (14th September 2021)

• Record Type: Journal Article
• Authors: Murphy, Julianne; Shin, Hye Jung; Wang, Hanyin; Luo, Yuan; Jahromi, Babak; Bleck, Thomas P.; Cella, David; Naidech, Andrew M.
• Is Part Of: Critical care explorations. Volume 3:Number 9(2021)
• Page Start: e0533
• Publication Date: 2021-09-14
• Subjects: outcomes research -- quality of life -- subarachnoid hemorrhage
• DOI: 10.1097/CCE.0000000000000533
• Languages: English
• ISSNs: 2639-8028

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : OBJECTIVES: Patients with aneurysmal subarachnoid hemorrhage (ruptured brain aneurysm) often have reduced health-related quality of life at follow-up in multiple domains (e.g., cognitive function and social function). We tested the hypothesis that there are distinct patterns of patient outcomes across domains of health-related quality of life, "complex patient outcomes, " in survivors of subarachnoid hemorrhage. DESIGN: Patients with subarachnoid hemorrhage were prospectively identified. Clinical data were prospectively recorded. Health-related quality of life was prospectively assessed at 3-month follow-up using the National Institutes of Health Patient Reported Outcomes Measurement Information System and neuro-quality of life in the domains of mobility, cognitive function, satisfaction with social roles, and depression. We used k-means clustering to analyze prospectively recorded health-related quality of life data, identifying clusters of complex patient outcomes. Decision tree analysis identified index hospital stay factors predictive of a patient having a particular complex patient outcome at follow-up. SETTING: Academic medical center. PATIENTS: One hundred three survivors of subarachnoid hemorrhage. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 103 patients, of whom 75 (72.8%) were female, and mean age was 53.6 ± 13.4 years. There were three complex patient outcomes: health-related quality of life greater than 1 sd better than the U.S. mean across all domains ( n = 23, 22.3%), health-related quality of life greater than 1 sd worse than U.S. mean across all domains ( n = 26, 25.2%), and satisfaction with social roles greater than 0.5 sd worse than U.S. mean with cognitive function, depression, and mobility scores near the U.S. mean ( n = 54, 52.4%). In decision tree analysis, hospital disposition and Hunt and Hess Grade were associated with complex patient outcome. CONCLUSIONS: Complex patient outcomes across multiple domains of health-related quality of life at follow-up after subarachnoid hemorrhage are distinct and may be predictable.