Long-Term Neuropsychiatric Outcomes After Nontraumatic Subarachnoid Hemorrhage: The Critical Role of Delayed Cerebral Ischemia

Long-Term Neuropsychiatric Outcomes After Nontraumatic Subarachnoid Hemorrhage: The Critical Role of Delayed Cerebral Ischemia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Long-Term Neuropsychiatric Outcomes After Nontraumatic Subarachnoid Hemorrhage: The Critical Role of Delayed Cerebral Ischemia Ali Seifi, Arash Salardini, Camila Guerrero Miranda, Travis Kotzur, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9285679/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Nontraumatic subarachnoid hemorrhage (SAH) often affects young adults, and survivors face long-term neuropsychiatric problems. We sought to determine the rate of neuropsychiatric outcomes and the impact of delayed cerebral ischemia (DCI) on these sequels. Methods Retrospective cohort study using TriNetX with five years follow up within 2013–2020. Adults with nontraumatic SAH were identified and propensity score matching was used across SAH without DCI, SAH with DCI, versus matched controls. Results Among 73,007 patients, those with SAH had a significantly increased risk of epilepsy (RR 11.25 [95% CI 9.95–12.71], p < 0.0001) and composite dementia (RR 4.02 [95% CI 3.72–4.35], p < 0.0001) compared to controls. DCI was associated with elevated risks of epilepsy (RR 18.92 [95% CI 12.68–28.24], p < 0.0001) and composite dementia (RR 6.98 [95% CI 5.39–9.05], p < 0.0001) versus controls. Clipping was associated with higher epilepsy (RR 1.48 [95% CI 1.19–1.83], p < 0.001) and dementia (RR 1.46 [95% CI 1.08–1.98], p = 0.013) compared to coiling. Survival analysis demonstrated worse neuropsychiatric event-free survival among SAH patients with DCI (HR 4.97 [95% CI 4.44–5.55], p < 0.001) compared to controls. Conclusions These findings demonstrate that SAH, particularly when complicated by DCI, is associated with substantially increased long-term risks of epilepsy and dementia, with clipping conferring additional epilepsy risk. Subarachnoid Hemorrhage Delayed Cerebral Ischemia Dementia Seizures Mood Disorders Surgical Clipping Endovascular Coiling Neuropsychiatry Figures Figure 1 Introduction Subarachnoid hemorrhage (SAH) accounts for about 5% of all strokes, but its effects on patients are extensive and chronic. Unlike other types of strokes that tend to happen in older patients, SAH often occurs at a younger age when people are working and raising families 1 . Because treatments have improved and more patients survive the initial bleed, there is a growing number of survivors living with long-term problems 2 . Many patients with good functional recovery after SAH still experience subtle cognitive symptoms that interfere with returning to their previous lives. A systematic review of 65 studies involving 6,832 patients found that 40%–70% of SAH survivors have measurable cognitive impairments 3 – 8 . About 30% of patients who survive the early period go on to develop delayed cerebral ischemia 9 , 10 . DCI involves problems in small blood vessels, microclots, abnormal cortical spreading depolarizations, and inflammation. All these things together reduce blood flow and damage brain tissue 11 . Several clinical trials, especially the CONSCIOUS studies, showed that treating vasospasm alone did not improve overall patient outcomes 12 . This shifted attention to DCI itself as a key player in long-term recovery, as this population is more likely to die or have lasting neuropsychological outcomes 10 , 13 . Studies suggest that cognitive problems 4 , 14 , memory trouble, difficulty with planning, focus, and attention often last for years. 3,15 Mood problems are also frequent; approximately 30% of survivors deal with depression, and anxiety is just as common 16 , 17 . These issues affect quality of life, work, and relationships, but they often get overlooked when clinicians only focus on whether someone can walk or care for themselves 18 , 19 . Despite growing awareness, we still lack large studies that look at the full range of neuropsychiatric problems after SAH and how DCI specifically contributes to them. Most research has focused either on cognition, mood or new onset seizures after SAH, and only a few studies have followed patients beyond the first year. With this in mind, we used a large national database with electronic health records to better understand the long-term neuropsychological outcomes of SAH. We aimed to answer three questions: First, how much higher are the risks of dementia, epilepsy, and mood disorders after SAH, compared to the control population? Second, does DCI further increase these risks among these patients? And third, how do these risks evolve over time? We hypothesized that nontraumatic SAH survivors would have higher rates of neuropsychiatric complications than the control population, and that those who had DCI would be worse. Methods This retrospective cohort study was performed using the TriNetX Research Network, a federated, multi-institutional database containing de-identified electronic health record data from academic and community health systems. The database includes patient demographics, diagnoses, procedures, medications, laboratory values, and longitudinal clinical outcomes and is compliant with HIPAA regulations. Our institution’s Institutional Review Board exempted this study from full review. Adult patients with nontraumatic subarachnoid hemorrhage (SAH) were identified using ICD-10-CM diagnosis codes for “nontraumatic” SAH (I60), hereafter referred to as SAH. To ensure a complete five-year follow-up period, patients were included only if their index diagnosis occurred between January 1, 2013 and December 31, 2020. All included patients were then followed longitudinally for up to five years after the index event, with outcomes captured through 2025. Delayed cerebral ischemia (DCI) was defined using proxy ICD-10-CM codes for cerebral ischemia (I67.82) and cerebral vasospasm/vasoconstriction (I67.84) occurring during the index hospitalization period. To evaluate incident neuropsychiatric outcomes, patients with preexisting diagnoses of dementia, epilepsy, mood disorders, psychotic disorders, or related conditions prior to index SAH were excluded using ICD-10-CM codes for depressive episodes (F32), recurrent major depressive disorder (F33), vascular dementia (F01), dementia in other diseases (F02), unspecified dementia (F03), Alzheimer’s disease (G30), epilepsy/recurrent seizures (G40), schizophrenia (F20), bipolar disorder (F31), adjustment disorders (F43), unspecified psychosis (F29), anxiety disorders (F41), and mild cognitive impairment (G31.84). Coil embolization (CPT: 61624 and 61626) or surgical clipping (CPT: 61697, 61698, 61700, and 61702) were analyzed as treatment modalities to assess their association with outcomes in SAH. Three comparisons were performed: (1) SAH versus a matched global control cohort, (2) SAH with DCI versus SAH without DCI, and (3) SAH with DCI versus matched controls. The control cohort consisted of a randomly selected population of patients with at least one ambulatory visit during the study period and no history of SAH. To reduce confounding, 1:1 propensity score matching (PSM) was performed using nearest-neighbor matching with a caliper of 0.1 pooled standard deviations. Matching covariates included age, sex, race, ethnicity, body mass index (BMI), hypertension, type 2 diabetes mellitus, ischemic heart disease, heart failure, chronic kidney disease, chronic lung disease, peripheral vascular disease, liver disease, and nicotine dependence. Patients who could not be matched were excluded from analysis, and minor differences in sample sizes across comparisons reflect cases excluded during propensity matching. Covariate balance was assessed using standardized mean differences (SMD), with values < 0.10 considered acceptable. Primary outcomes included incident neuropsychiatric diagnoses following SAH, including composite dementia, Alzheimer’s disease, vascular dementia, epilepsy/recurrent seizures, mood/anxiety disorders (composite), depression, anxiety disorders, and bipolar disorder. Composite dementia was defined as any diagnosis of Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, or unspecified dementia. Composite mood/anxiety outcomes included depressive disorders, anxiety disorders, stress-related disorders, bipolar disorder, schizophrenia, and psychosis not otherwise specified. Cumulative incidence was assessed using Kaplan–Meier methodology, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Statistical significance was defined as p < 0.05. Results Baseline Characteristics A total of 73,007 patients with SAH were identified. After propensity matching, 72,976 matched pairs were included in the SAH versus control comparison. Patients with SAH had a mean age of 56.5 ± 20.8 years and were 47.2% female. Following matching, all demographic and clinical covariates were well balanced with standardized mean differences below 0.10 across all variables (Table 1). Table 1 Subarachnoid Hemorrhage vs Control Demographics Characteristic SAH (n = 73,007) Global Cohort (n = 4,479,343) SMD (Before) SAH (n = 72,976) Global Cohort (n = 72,976) SMD (After) Age, years 56.5 ± 20.9 53.3 ± 14.0 0.184 56.5 ± 20.8 58.3 ± 15.7 0.095 Age 18–55 29,404 (40.3%) 2,337,348 (52.2%) 0.241 29,404 (40.3%) 29,352 (40.2%) 0.001 Age 55–65 14,917 (20.4%) 1,043,620 (23.3%) 0.069 14,917 (20.4%) 14,919 (20.4%) < 0.001 Age 65–80 18,977 (26.0%) 1,004,794 (22.4%) 0.083 18,977 (26.0%) 19,018 (26.1%) 0.001 Age ≥ 80 9,709 (13.3%) 93,581 (2.1%) 0.430 9,678 (13.3%) 9,687 (13.3%) < 0.001 White race 46,992 (64.4%) 2,311,907 (51.6%) 0.261 46,966 (64.4%) 46,979 (64.4%) < 0.001 Female sex 34,439 (47.2%) 2,556,380 (57.1%) 0.199 34,430 (47.2%) 34,350 (47.1%) 0.002 Hispanic ethnicity 5,575 (7.6%) 111,838 (2.5%) 0.236 5,568 (7.6%) 5,629 (7.7%) 0.003 BMI, kg/m² 27.46 ± 6.50 30.24 ± 7.10 0.408 27.47 ± 6.51 28.37 ± 6.01 0.143 BMI ≤ 30 13,979 (19.2%) 327,985 (7.3%) 0.354 13,949 (19.1%) 13,872 (19.0%) 0.003 BMI 30–35 4,531 (6.2%) 159,473 (3.6%) 0.123 4,524 (6.2%) 4,496 (6.2%) 0.002 BMI ≥ 35 2,797 (3.8%) 135,520 (3.0%) 0.044 2,794 (3.8%) 2,711 (3.7%) 0.006 Hypertension 11,780 (16.1%) 318,605 (7.1%) 0.284 11,755 (16.1%) 11,781 (16.1%) 0.001 Type 2 diabetes mellitus 4,553 (6.2%) 137,063 (3.1%) 0.151 4,542 (6.2%) 4,506 (6.2%) 0.002 Ischemic heart disease 4,461 (6.1%) 77,534 (1.7%) 0.227 4,434 (6.1%) 4,395 (6.0%) 0.002 Peripheral vascular disease 3,349 (4.6%) 43,218 (1.0%) 0.222 3,323 (4.6%) 3,328 (4.6%) < 0.001 Chronic lung disease 2,903 (4.0%) 82,495 (1.8%) 0.127 2,889 (4.0%) 2,862 (3.9%) 0.002 Nicotine dependence 2,700 (3.7%) 52,549 (1.2%) 0.164 2,691 (3.7%) 2,726 (3.7%) 0.003 Chronic kidney disease 2,572 (3.5%) 50,504 (1.1%) 0.159 2,559 (3.5%) 2,303 (3.2%) 0.020 Heart failure 2,466 (3.4%) 27,973 (0.6%) 0.198 2,437 (3.3%) 2,347 (3.2%) 0.007 Liver disease 931 (1.3%) 15,445 (0.3%) 0.104 923 (1.3%) 864 (1.2%) 0.007 Abbreviations: SAH = subarachnoid hemorrhage; SMD = standardized mean difference; BMI = body mass index Table 1. Baseline Demographic and Clinical Characteristics of SAH Patients and Matched Controls Before and After Propensity Score Matching Note: Minor differences in sample sizes reflect cases excluded during propensity matching due to lack of suitable matches. SMD <0.10 indicates adequate balance after matching. In the DCI versus non-DCI SAH analysis, 5,301 matched pairs were included. Patients with DCI were slightly older than those without DCI (59.2 ± 16.5 vs 56.9 ± 20.0 years; SMD = 0.123), while all other baseline characteristics were well balanced after matching (all SMD < 0.05). Similarly, in the DCI versus matched control comparison (5,299 pairs), all baseline covariates demonstrated adequate balance after matching (all SMD < 0.10) (Tables 2 and 3). Table 2 Delayed Cerebral Ischemia vs No Delayed Cerebral Ischemia Demographics Characteristic SAH w/ DCI (n = 5,301) SAH w/o DCI (n = 68,390) SMD (Before) SAH w/ DCI (n = 5,301) SAH w/o DCI (n = 5,301) SMD (After) Age, years 59.2 ± 16.5 56.4 ± 21.1 0.148 59.2 ± 16.5 56.9 ± 20.0 0.123 Age 18–55 2,055 (38.8%) 27,583 (40.3%) 0.032 2,055 (38.8%) 2,049 (38.7%) 0.002 Age 55–65 1,266 (23.9%) 13,798 (20.2%) 0.090 1,266 (23.9%) 1,271 (24.0%) 0.002 Age 65–80 1,328 (25.1%) 17,840 (26.1%) 0.024 1,328 (25.1%) 1,327 (25.0%) < 0.001 Age ≥ 80 652 (12.3%) 9,169 (13.4%) 0.033 652 (12.3%) 654 (12.3%) 0.001 White race 3,458 (65.2%) 43,980 (64.3%) 0.019 3,458 (65.2%) 3,478 (65.6%) 0.008 Female sex 3,204 (60.4%) 31,683 (46.3%) 0.286 3,204 (60.4%) 3,213 (60.6%) 0.003 Hispanic ethnicity 504 (9.5%) 5,124 (7.5%) 0.072 504 (9.5%) 490 (9.2%) 0.009 BMI, kg/m² 27.71 ± 6.54 27.45 ± 6.49 0.040 27.71 ± 6.54 27.62 ± 6.38 0.013 BMI ≤ 30 1,559 (29.4%) 13,068 (19.1%) 0.242 1,559 (29.4%) 1,578 (29.8%) 0.008 BMI 30–35 567 (10.7%) 4,214 (6.2%) 0.164 567 (10.7%) 577 (10.9%) 0.006 BMI ≥ 35 338 (6.4%) 2,603 (3.8%) 0.117 338 (6.4%) 325 (6.1%) 0.010 Hypertension 1,676 (31.6%) 10,924 (16.0%) 0.374 1,676 (31.6%) 1,684 (31.8%) 0.003 Type 2 diabetes mellitus 557 (10.5%) 4,243 (6.2%) 0.156 557 (10.5%) 545 (10.3%) 0.007 Ischemic heart disease 552 (10.4%) 4,146 (6.1%) 0.159 552 (10.4%) 549 (10.4%) 0.002 Peripheral vascular disease 677 (12.8%) 3,057 (4.5%) 0.299 677 (12.8%) 657 (12.4%) 0.011 Chronic lung disease 364 (6.9%) 2,692 (3.9%) 0.130 364 (6.9%) 402 (7.6%) 0.028 Nicotine dependence 397 (7.5%) 2,510 (3.7%) 0.167 397 (7.5%) 392 (7.4%) 0.004 Chronic kidney disease 285 (5.4%) 2,412 (3.5%) 0.090 285 (5.4%) 324 (6.1%) 0.032 Heart failure 331 (6.2%) 2,292 (3.4%) 0.136 331 (6.2%) 324 (6.1%) 0.005 Liver disease 99 (1.9%) 883 (1.3%) 0.046 99 (1.9%) 83 (1.6%) 0.023 Abbreviations: SAH = subarachnoid hemorrhage; DCI = delayed cerebral ischemia; SMD = standardized mean difference; BMI = body mass index Table 2. Baseline Demographic and Clinical Characteristics of SAH Patients With and Without Delayed Cerebral Ischemia Before and After Propensity Score Matching Note: Minor differences in sample sizes reflect cases excluded during propensity matching. SMD <0.10 indicates adequate balance after matching. Table 3 Delayed Cerebral Ischemia vs Control Demographics Characteristic SAH w/ DCI (n = 5,301) Control Cohort (n = 4,479,343) SMD (Before) SAH w/ DCI (n = 5,299) Control Cohort (n = 5,299) SMD (After) Age, years 59.2 ± 16.5 53.3 ± 14.0 0.386 59.2 ± 16.5 58.6 ± 15.1 0.036 Age 18–55 2,055 (38.8%) 2,337,348 (52.2%) 0.272 2,055 (38.8%) 2,033 (38.4%) 0.009 Age 55–65 1,266 (23.9%) 1,043,620 (23.3%) 0.014 1,266 (23.9%) 1,275 (24.1%) 0.004 Age 65–80 1,328 (25.1%) 1,004,794 (22.4%) 0.062 1,327 (25.0%) 1,334 (25.2%) 0.003 Age ≥ 80 652 (12.3%) 93,581 (2.1%) 0.403 651 (12.3%) 657 (12.4%) 0.003 White race 3,458 (65.2%) 2,311,907 (51.6%) 0.279 3,457 (65.2%) 3,460 (65.3%) 0.001 Female sex 3,204 (60.4%) 2,556,380 (57.1%) 0.069 3,202 (60.4%) 3,207 (60.5%) 0.002 Hispanic ethnicity 504 (9.5%) 111,838 (2.5%) 0.298 503 (9.5%) 516 (9.7%) 0.008 BMI, kg/m² 27.71 ± 6.54 30.24 ± 7.10 0.370 27.72 ± 6.54 28.29 ± 5.86 0.093 BMI ≤ 30 1,559 (29.4%) 327,985 (7.3%) 0.595 1,557 (29.4%) 1,545 (29.2%) 0.005 BMI 30–35 567 (10.7%) 159,473 (3.6%) 0.280 567 (10.7%) 569 (10.7%) 0.001 BMI ≥ 35 338 (6.4%) 135,520 (3.0%) 0.159 337 (6.4%) 314 (5.9%) 0.018 Hypertension 1,676 (31.6%) 318,605 (7.1%) 0.652 1,674 (31.6%) 1,682 (31.7%) 0.003 Type 2 diabetes mellitus 557 (10.5%) 137,063 (3.1%) 0.299 556 (10.5%) 567 (10.7%) 0.007 Ischemic heart disease 552 (10.4%) 77,534 (1.7%) 0.370 551 (10.4%) 554 (10.5%) 0.002 Peripheral vascular disease 677 (12.8%) 43,218 (1.0%) 0.480 675 (12.7%) 663 (12.5%) 0.007 Chronic lung disease 364 (6.9%) 82,495 (1.8%) 0.248 363 (6.9%) 354 (6.7%) 0.007 Nicotine dependence 397 (7.5%) 52,549 (1.2%) 0.314 396 (7.5%) 404 (7.6%) 0.006 Chronic kidney disease 285 (5.4%) 50,504 (1.1%) 0.241 284 (5.4%) 295 (5.6%) 0.009 Heart failure 331 (6.2%) 27,973 (0.6%) 0.312 329 (6.2%) 324 (6.1%) 0.004 Liver disease 99 (1.9%) 15,445 (0.3%) 0.146 98 (1.9%) 84 (1.6%) 0.020 Abbreviations: SAH = subarachnoid hemorrhage; DCI = delayed cerebral ischemia; SMD = standardized mean difference; BMI = body mass index Table 3. Baseline Demographic and Clinical Characteristics of SAH Patients With Delayed Cerebral Ischemia and Matched Controls Before and After Propensity Score Matching Note: Minor differences in sample sizes reflect cases excluded during propensity matching. All covariates achieved adequate balance after matching with SMD <0.10. Neuropsychiatric Outcomes In the SAH versus matched control comparison, SAH was associated with significantly higher risks of all evaluated neuropsychiatric outcomes. Composite dementia occurred in 4.19% of SAH patients versus 1.04% of controls (RR 4.02 [, 95% CI (3.72–4.35), p < 0.0001]). SAH was also associated with increased risks of Alzheimer's disease (RR 2.16 [, 95% CI (1.82–2.57), p < 0.0001]), vascular dementia (RR 5.87 [, 95% CI (4.76–7.25), p < 0.0001]), epilepsy/recurrent seizures (RR 11.25 [, 95% CI (9.95–12.71), p < 0.0001]), mood/anxiety disorders (RR 1.66 [, 95% CI (1.60–1.72), p < 0.0001]), depression (RR 2.08 [, 95% CI (1.98–2.19), p < 0.0001]), anxiety disorders (RR 1.51 [, 95% CI (1.45–1.58), p < 0.0001]), and bipolar disorder (RR 1.56 [, 95% CI (1.29–1.88), p < 0.0001]) (Table 4). Table 4 Subarachnoid Hemorrhage vs Control Outcomes Outcome SAH (n = 73,001) Control (n = 73,001) Risk Difference (95% CI) Risk Ratio (95% CI) p Dementia (composite)* 3,057 (4.188%) 760 (1.041%) 3.147% (2.984%, 3.309%) 4.022 (3.718, 4.352) < 0.0001 Alzheimer’s disease 413 (0.566%) 191 (0.262%) 0.304% (0.238%, 0.370%) 2.162 (1.822, 2.566) < 0.0001 Vascular dementia 593 (0.812%) 101 (0.138%) 0.674% (0.603%, 0.744%) 5.871 (4.756, 7.249) < 0.0001 Epilepsy / recurrent seizures 3,104 (4.252%) 276 (0.378%) 3.874% (3.721%, 4.027%) 11.246 (9.948, 12.714) < 0.0001 Mood/anxiety (composite) † 7,622 (10.441%) 4,590 (6.288%) 4.153% (3.870%, 4.437%) 1.661 (1.603, 1.720) < 0.0001 Depression 4,451 (6.097%) 2,142 (2.934%) 3.163% (2.951%, 3.375%) 2.078 (1.976, 2.186) < 0.0001 Anxiety disorder 5,041 (6.905%) 3,332 (4.564%) 2.341% (2.103%, 2.579%) 1.513 (1.450, 1.579) < 0.0001 Bipolar disorder 285 (0.390%) 183 (0.251%) 0.140% (0.082%, 0.198%) 1.557 (1.294, 1.875) < 0.0001 * The composite dementia outcome was defined as the occurrence of any of the following dementia diagnoses: Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, unspecified dementia † The composite mood/anxiety outcome was defined as the occurrence of any of the following diagnoses: depressive episode, major depressive disorder, other anxiety disorders, reaction to severe stress and adjustment disorders, bipolar disorder, schizophrenia, or unspecified psychosis not due to a substance or known physiological condition Table 4. Risk of Neuropsychiatric Outcomes in SAH Patients Compared to Matched Controls Abbreviation Definition SAH subarachnoid hemorrhage RR risk ratio CI confidence interval Note: Composite dementia includes Alzheimer's disease, vascular dementia, dementia in other diseases classified elsewhere, and unspecified dementia. Composite mood/anxiety includes depressive disorders, anxiety disorders, stress-related disorders, bipolar disorder, schizophrenia, and unspecified psychosis. Among patients with SAH, those who developed DCI experienced significantly worse neuropsychiatric outcomes compared with matched SAH patients without DCI. Composite dementia occurred in 8.45% versus 4.85% (RR 1.74 [, 95% CI (1.50–2.02), p < 0.0001]). DCI was also associated with increased risks of vascular dementia (RR 2.12 [, 95% CI (1.52–2.94), p < 0.0001]), epilepsy/recurrent seizures (RR 2.04 [, 95% CI (1.75–2.38), p < 0.0001]), mood/anxiety disorders (RR 1.56 [, 95% CI (1.42–1.71), p < 0.0001]), depression (RR 1.67 [, 95% CI (1.48–1.89), p < 0.0001]), and anxiety disorders (RR 1.42 [, 95% CI (1.26–1.59), p < 0.0001]), while no significant differences were observed for Alzheimer's disease or bipolar disorder (Table 5). Table 5 Delayed Cerebral Ischemia vs. No Delayed Cerebral Ischemia Outcomes Outcome SAH w/ DCI (n = 5,301) SAH w/o DCI (n = 5,301) Risk Difference (95% CI) Risk Ratio (95% CI) p-value Dementia (composite)* 448 (8.451%) 257 (4.848%) 3.603% (2.657%, 4.549%) 1.743 (1.503, 2.022) < 0.0001 Alzheimer’s disease 51 (0.962%) 40 (0.755%) 0.208% (-0.144%, 0.559%) 1.275 (0.844, 1.925) 0.2468 Vascular dementia 110 (2.075%) 52 (0.981%) 1.094% (0.628%, 1.561%) 2.115 (1.524, 2.936) < 0.0001 Epilepsy / recurrent seizures 474 (8.942%) 232 (4.377%) 4.565% (3.620%, 5.510%) 2.043 (1.754, 2.379) < 0.0001 Mood/anxiety (composite) † 971 (18.317%) 623 (11.752%) 6.565% (5.210%, 7.920%) 1.559 (1.420, 1.711) < 0.0001 Depression 632 (11.922%) 378 (7.131%) 4.792% (3.678%, 5.906%) 1.672 (1.480, 1.888) < 0.0001 Anxiety disorder 606 (11.432%) 428 (8.074%) 3.358% (2.230%, 4.486%) 1.416 (1.259, 1.593) < 0.0001 Bipolar disorder 28 (0.528%) 19 (0.358%) 0.170% (-0.083%, 0.423%) 1.474 (0.824, 2.636) 0.1883 * The composite dementia outcome was defined as the occurrence of any of the following dementia diagnoses: Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, unspecified dementia † The composite mood/anxiety outcome was defined as the occurrence of any of the following diagnoses: depressive episode, major depressive disorder, other anxiety disorders, reaction to severe stress and adjustment disorders, bipolar disorder, schizophrenia, or unspecified psychosis not due to a substance or known physiological condition Table 5. Risk of Neuropsychiatric Outcomes in SAH Patients With DCI Compared to Matched SAH Patients Without DCI Abbreviation Definition SAH subarachnoid hemorrhage DCI delayed cerebral ischemia RR risk ratio CI confidence interval Note: Composite dementia and composite mood/anxiety definitions are identical to those in Table 4. No significant differences were observed for Alzheimer's disease or bipolar disorder. When compared with matched controls, patients with DCI demonstrated markedly elevated risks across nearly all outcomes, including composite dementia (RR 6.98 [, 95% CI (5.39–9.05), p < 0.0001]), Alzheimer's disease (RR 5.10 [, 95% CI (2.59–10.03), p < 0.0001]), epilepsy/recurrent seizures (RR 18.92 [, 95% CI (12.68–28.24), p < 0.0001]), mood/anxiety disorders (RR 2.98 [, 95% CI (2.65–3.36), p < 0.0001]), depression (RR 3.89 [, 95% CI (3.29–4.60), p < 0.0001]), anxiety disorders (RR 2.60 [, 95% CI (2.25–3.01), p < 0.0001]), and bipolar disorder (RR 2.33 [, 95% CI (1.19–4.58), p = 0.011]) (Table 6). Table 6 Delayed Cerebral Ischemia vs. Control Outcomes Outcome SAH w/ DCI (n = 5,297) Control (n = 5,297) Risk Difference (95% CI) Risk Ratio (95% CI) p Dementia (composite)* 447 (8.439%) 64 (1.208%) 7.231% (6.426%, 8.035%) 6.984 (5.390, 9.051) < 0.0001 Alzheimer’s disease 51 (0.963%) ≤ 10 (0.189%) 0.774% (0.486%, 1.062%) 5.10 (2.592, 10.034) < 0.0001 Vascular dementia** - - - - - Epilepsy / recurrent seizures 473 (8.93%) 25 (0.472%) 8.458% (7.668%, 9.247%) 18.92 (12.677, 28.237) < 0.0001 Mood/anxiety (composite) † 969 (18.293%) 325 (6.136%) 12.158% (10.932%, 13.383%) 2.982 (2.645, 3.361) < 0.0001 Depression 630 (11.894%) 162 (3.058%) 8.835% (7.848%, 9.823%) 3.889 (3.286, 4.602) < 0.0001 Anxiety disorder 604 (11.403%) 232 (4.38%) 7.023% (6.005%, 8.041%) 2.603 (2.249, 3.014) < 0.0001 Bipolar disorder 28 (0.529%) 12 (0.227%) 0.302% (0.069%, 0.536%) 2.333 (1.188, 4.584) 0.0113 * The composite dementia outcome was defined as the occurrence of any of the following dementia diagnoses: Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, unspecified dementia † The composite mood/anxiety outcome was defined as the occurrence of any of the following diagnoses: depressive episode, major depressive disorder, other anxiety disorders, reaction to severe stress and adjustment disorders, bipolar disorder, schizophrenia, or unspecified psychosis not due to a substance or known physiological condition ** Vascular Dementia was censored due to a low number of events in the control group. Table 6. Risk of Neuropsychiatric Outcomes in SAH Patients With DCI Compared to Matched Controls Abbreviation Definition DCI delayed cerebral ischemia SAH subarachnoid hemorrhage RR risk ratio CI confidence interval Note: Vascular dementia was censored due to low event counts in the control group. Composite dementia and composite mood/anxiety definitions are identical to those in Table 4. Treatment Modality: Clipping versus Coiling Among patients with SAH, those who underwent surgical clipping had higher risks of certain neuropsychiatric outcomes compared with propensity-matched patients who received endovascular coiling. The strongest association was observed in epilepsy and recurrent seizures, which were significantly more common in the clipping group, occurring in 10.67% versus 7.23% (RR 1.48 [, 95% CI (1.19–1.83), p < 0.001]). Composite dementia occurred in 5.62% of clipped patients versus 3.84% of coiled patients (RR 1.46 [, 95% CI (1.08–1.98), p = 0.013]). No statistically significant differences were observed between treatment modalities for vascular dementia (RR 1.31 [, 95% CI (0.64–2.68), p = 0.463]), mood/anxiety disorders (RR 1.09 [, 95% CI (0.94–1.26), p = 0.243]), depression (RR 1.01 [, 95% CI (0.82–1.23), p = 0.955]), or anxiety disorders (RR 1.17 [, 95% CI (0.97–1.42), p = 0.095]). Outcomes for Alzheimer's disease and bipolar disorder could not be assessed due to low event counts (Table 7). Table 7 Surgical Clipping vs Endovascular Coiling Outcomes Outcome SAH Clipping (n = 1,743) SAH Coil (n = 1,743) Risk Difference (95% CI) Risk Ratio (95% CI) p Dementia (composite)* 98 (5.622%) 67 (3.844%) 1.779% (0.37%, 3.187%) 1.463 (1.08, 1.981) 0.0134 Alzheimer’s disease** - - - - - Vascular dementia 17 (0.975%) 13 (0.746%) 0.229% (-0.384%, 0.843%) 1.308 (0.637, 2.684) 0.4633 Epilepsy / recurrent seizures 186 (10.671%) 126 (7.229%) 3.442% (1.55%, 5.334%) 1.476 (1.189, 1.832) 0.0004 Mood/anxiety (composite)† 312 (17.900%) 286 (16.408%) 1.492% (-1.011%, 3.994%) 1.091 (0.943, 1.262) 0.2428 Depression 173 (9.925%) 172 (9.868%) 0.057% (-1.925%, 2.04%) 1.006 (0.823, 1.229) 0.9548 Anxiety disorder 209 (11.991%) 178 (10.212%) 1.779% (-0.306%, 3.863%) 1.174 (0.972, 1.418) 0.0947 Bipolar disorder** - - - - - * The composite dementia outcome was defined as the occurrence of any of the following dementia diagnoses: Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, unspecified dementia † The composite mood/anxiety outcome was defined as the occurrence of any of the following diagnoses: depressive episode, major depressive disorder, other anxiety disorders, reaction to severe stress and adjustment disorders, bipolar disorder, schizophrenia, or unspecified psychosis not due to a substance or known physiological condition ** Detailed TriNetX results were not displayed because of low event counts. Table 7. Risk of Neuropsychiatric Outcomes in SAH Patients Treated with Surgical Clipping Compared to Endovascular Coiling Abbreviation Definition SAH subarachnoid hemorrhage RR risk ratio CI confidence interval Note: Outcomes for Alzheimer's disease and bipolar disorder could not be assessed due to low event counts. Composite dementia and composite mood/anxiety definitions are identical to those in Table 4. Cumulative Incidence Modeling Kaplan–Meier analysis demonstrated progressively higher cumulative incidence of neuropsychiatric outcomes across cohorts. The cumulative event probability was highest in the SAH with DCI group (37.52%), followed by SAH without DCI (26.45%), and lowest in the control cohort (11.39%). Compared with controls, both SAH without DCI (HR 2.95, 95% CI 2.86–3.05, p < 0.001) and SAH with DCI (HR 4.97, 95% CI 4.44–5.55, p < 0.001) were associated with significantly increased risk (Fig. 1). Discussion Our study shows that SAH is associated significantly with elevated long-term risks of neuropsychiatric sequelae over five years of follow-up. Compared to the control, SAH patients had four-fold increased risk of composite dementia, an eleven-fold increased risk of epilepsy, and a two-fold increased risk of depression. Among those who developed DCI, outcomes were even worse: a seven-fold increased risk of dementia, an eighteen-fold risk of epilepsy, and a three-fold risk of mood/anxiety disorders compared to matched controls. DCI and Cognitive Decline Our findings support and substantially extend prior smaller studies 3 , 9 , 11 , 14 , 19 – 27 . Stienen et al. 19 reported that DCI patients faced a nearly five-fold increased risk of moderate-to-severe neuropsychological deficits, while Springer et al. 20 , found that global cognitive impairment at one year post-SAH was 3.6 times more frequent in DCI patients and adversely affected functional recovery and quality of life. With over 5,000 matched pairs in our DCI versus non-DCI analysis, we now provide robust evidence that this association extends to formal dementia diagnoses, particularly vascular dementia, and that the risk continues to accrue over five years, supporting the concept that DCI triggers an ongoing, cumulative neurodegenerative process rather than a static insult 9 , 11 , 19 – 27 . From a psychiatric perspective, post-SAH cognitive impairment frequently presents with prominent executive dysfunction and frontal–subcortical features that may overlap with or be amplified by mood symptoms. This overlap underscores the need for integrated neuropsychological and psychiatric evaluation to distinguish primary neurodegenerative processes from reversible contributors, such as depression (pseudodementia) or anxiety-related inattention. 16 , 28 Biologically, this progression can be explained by DCI-induced scattered microinfarcts through vasospasm, microthrombosis, cortical spreading depolarizations, and neuroinflammation, which accumulate over time and progressively impair cognitive function 3 , 9 , 11 , 14 , 19 – 27 . Our observation of a divergence between DCI and non-DCI patients over five years aligns with the temporal patterns reported by Wenneberg et al. 3 and Walter et al. 21 , who noted that DCI-related deficits emerge at 2–3 years but were preserved during the first year, and by Olsen et al. 22 , who demonstrated excess mortality over four years. Stienen et al. 23 further provided prospective evidence that DCI independently contributes to neuropsychological deterioration by using serial MoCA assessments before and after the DCI period, and Eagles et al. 14 confirmed this association using the CONSCIOUS-1 dataset 3 , 14 , 19 – 23 . The underlying mechanisms are increasingly evolving. Neuroinflammation plays a central role, with elevated cerebrospinal fluid levels of IL-1β, TNF-α, and IL-6 observed in patients with poor outcomes 24 , 25 . These mediators may persist chronically, promoting ongoing neurodegeneration. Additional contributors include hemosiderin deposition from superficial siderosis, hydrocephalus, and microvascular dysfunction 27 . Given these pathways, early therapeutic interventions, such as anti-inflammatory agents, iron chelation, or antithrombotic therapy, warrant investigation as potential strategies to mitigate DCI-related cognitive decline 24 – 27 . Epilepsy After SAH and DCI Our study demonstrates a very high risk of epilepsy following SAH, with SAH patients exhibiting an eleven-fold increased incidence compared to matched controls, further amplified to an eighteen-fold increase among those with DCI, which is consistent with previous studies documenting that seizures and epilepsy are increased after SAH 17 , 29 . The pathogenesis is likely multifactorial; direct cortical injury from the initial hemorrhage, epileptogenic effects of hemosiderin deposition due to superficial siderosis, and ischemic damage from DCI, all of which may create cortical irritability and seizure foci 27 . Huttunen, et al. identified several risk factors for post-SAH epilepsy, including early seizures, severe hemorrhage, and middle cerebral artery aneurysms 30 . Our findings add DCI to that list as a contributor, aligned with other studies that show DCI is an independent risk factor for seizures after SAH 11 , 29 – 31 . The 2023 AHA/ASA guideline does not recommend routine antiseizure prophylaxis and provides no specific duration for high-risk patients, including those with DCI-related cortical infarction; the 7-day recommendation applies only to patients with new-onset seizures, not to those receiving prophylaxis 32 . However, the near nineteen-fold higher rate of seizure among SAH patients with DCI in our five-year cohort underscores the need for prospective randomized trials regarding seizure prophylaxis and potentially targeted treatment in this high-risk subgroup. Mood Disorders Psychiatric morbidities were common in our cohort. Patients with SAH, particularly those with DCI, had a significantly higher risk of depression, mood/anxiety (composite) and anxiety disorders as compared to the control group. In a meta-analysis by Tang et al., which included 35 studies and 5,217 patients, the reported prevalence of depression after SAH ranged from 0% to 61.7%, with a pooled prevalence of 28.1%. Depression was assessed between 4 days and 10.1 years after ictus, with pooled prevalences of 32.2% within the first year and 27.3% beyond one year following the hemorrhage 16 . The near four-fold increase in risk we found in depression is meaningful and matches what others have found. In a smaller study of 226 SAH patients, Stienen, et al reported a five-fold increase in moderate-to-severe neuropsychological problems after DCI 19 . Impact of SAH and DCI on the patients’ mood is more likely multifactorial. Damage to brain circuits involved in emotions, particularly in the frontal and limbic areas, could play a role. Moreover, going through a life-threatening event, dealing with new cognitive limits, and struggling to return to work or normal life all take an emotional toll 17 . Mood disorders in SAH survivors frequently involve a bidirectional relationship with cognitive deficits, depression and anxiety can worsen perceived cognitive impairment and reduce rehabilitation engagement, while residual brain injury may contribute to persistent emotional dysregulation. This cycle is well-documented in post-SAH literature and amenable to psychiatric intervention. 16 , 33 The fact that DCI patients had higher rates of mood problems even after matching for other health issues suggests that the extra brain injury from ischemia adds to the burden. In a translational SAH animal model, delayed depression and memory impairment were observed and associated with disruption of astrocytic glutamate transporter-1 (GLT-1)–mediated glutamate homeostasis. The study demonstrated that histone deacetylase-2 (HDAC2) regulates GLT-1 transcription, contributing to the development of delayed cognitive impairment after SAH. These findings also suggest that HDAC2 inhibitors may represent a potential therapeutic strategy for cognitive dysfunction following SAH 34 . Routine psychiatric screening in follow-up clinics (e.g., PHQ-9, GAD-7), coupled with early initiation of evidence-based treatments such as SSRIs and brief, tailored cognitive-behavioral therapy, may improve outcomes and quality of life in SAH survivors. 16 , 35 , 36 These strategies should be incorporated into standard multidisciplinary care pathways. Treatment Modality: Coil vs Clipping Our study demonstrates that among patients with SAH, those treated with surgical clipping had significantly higher long-term risks of neuropsychiatric complications compared to those who underwent endovascular coiling. Clipped patients experienced higher rates of composite dementia and epilepsy, while no significant differences were observed between treatment modalities for mood and anxiety disorders. These findings align with the International Subarachnoid Aneurysm Trial (ISAT), which reported better cognitive outcomes and lower seizure rates in coiled patients at one and five years 29 , 37 . Similarly, Latimer, et al. found that coiled patients had superior global cognitive performance, including higher IQ and better memory function 38 . The mechanisms underlying these differences likely relate to the inherent nature of surgical clipping, which requires craniotomy and brain retraction, particularly of the frontal and temporal lobes, potentially causing direct cortical injury, gliosis, and subsequent epileptogenesis. Endovascular coiling, by contrast, avoids these mechanical insults to the brain parenchyma 17 , 18 . Notably, mood and anxiety disorders were similarly distributed between treatment groups. This suggests that the psychological burden of SAH may be driven predominantly by disease-related factors, including the existential impact of a life-threatening event and chronic cognitive impairment, rather than the specific treatment approach 16 . This finding suggests that while surgical clipping confers a greater risk of dementia and epilepsy, all survivors warrant longitudinal comprehensive neuropsychiatric surveillance regardless of treatment modality. Cumulative Incidence: Kaplan-Meier analysis revealed a progressive gradient of neuropsychiatric risk across cohorts over five years of follow-up. Patients with SAH who developed DCI exhibited the poorest outcomes, with a 37.5% cumulative probability of developing a neuropsychiatric condition, compared to 26.45% among SAH patients without DCI. The progressively diverging survival curves during five years indicate that the neuropsychiatric sequelae of SAH, particularly DCI, represent ongoing, cumulative processes rather than static deficits, with the adverse impact becoming increasingly apparent over time. This temporal pattern aligns with prior studies: Wenneberg et al. observed that DCI-related deficits emerged at three years but not at one year; Olsen et al. demonstrated excess mortality over four years; and Stienen et al. documented persistent neuropsychological decline from baseline through three months post-SAH 3 , 22 , 23 . Critically, our five-year follow-up extends these observations by demonstrating that the gap between DCI and non-DCI patients continues to widen beyond previously reported time points; a novel finding indicates that DCI triggers progressive, cumulative neuropsychiatric decline rather than an isolated early injury 3 , 22 , 23 . These results underscore the necessity of prolonged, structured neuropsychiatric surveillance for SAH survivors, particularly those who experience DCI (Fig. 1 ). Clinical Implications SAH survivors require surveillance beyond angiographic follow-up, including routine assessment for cognitive deficits, mood disturbances, and seizures, as functional scales may underestimate impairment 14 . DCI should be recognized as a marker of elevated long-term neuropsychiatric risk, given that deficits may not manifest for a year or more 3 . These data support multidisciplinary care models incorporating neuropsychology, stroke nursing, and rehabilitation medicine 17 , 18 , as well as mental health interventions including SSRIs, cognitive-behavioral therapy, and potentially HDAC2 inhibitors 17 , 34 , 39 . Finally, clinical trials should incorporate standardized cognitive and mood assessments to capture treatment effects missed by mortality or functional outcomes alone 40 . Limitations This study has several limitations worth keeping in mind. We used administrative data and diagnosis codes, which can lead to misclassification or undercounting of outcomes. Mild cognitive problems and subtle mood changes often do not receive formal diagnoses in routine care, suggesting possible underestimation of the true rates. Defining DCI by reported codes is imperfect; these codes are a proxy for DCI and don't map exactly onto the Vergouwen consensus definition. 41 We could not apply the strict clinical criteria that prospective studies use. Additionally, despite propensity matching, we cannot rule out residual confounding. We lacked information on variables, such as education level, socioeconomic status, severity of the initial bleed, or details about aneurysm location and treatment type. We were also unable to grade hemorrhage severity using scales such as Fisher scale, and we could not measure how severe the neuropsychiatric outcomes were. Dementia code does not distinguish between someone with mild forgetfulness or requiring fulltime care. Finally, this is an observational study, thus we cannot prove that SAH causes these outcomes, only that they are strongly linked. Despite these limitations, the large sample size, prolonged 5-years of follow-up, careful matching, multiple comparison groups, and time-to-event analysis allow us to provide robust estimates of the long-term neuropsychiatric burden of SAH and the specific contribution of DCI. Conclusions This large study of SAH survivors with a five-year follow-up quantifies the substantial long-term neuropsychiatric burden of SAH and establishes DCI as a driver of progressive, cumulative decline. SAH patients faced a four-fold higher risk of dementia and eleven-fold higher risk of epilepsy than matched controls, with DCI amplifying these risks to seven-fold and eighteen-fold, respectively, representing the largest risk magnitudes reported to date. Unlike prior studies with a shorter follow-up, we demonstrate that the gap between DCI and non-DCI patients continues to widen over five years, indicating that DCI triggers ongoing neurodegeneration rather than static injury. Surgical clipping independently increased dementia and epilepsy risks compared to coiling over an extended follow-up. These results reframe SAH as a chronic condition with progressive brain health consequences, necessitating long-term multidisciplinary surveillance. Future clinical trials must incorporate neuropsychiatric outcomes to fully capture treatment efficacy. Declarations Disclosures: The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Sources of Funding: This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Previous Presentations: None. Acknowledgments: None. Ethics Approval: This study was deemed exempt from full review by the Institutional Review Board of the University of Texas Health San Antonio due to the use of de-identified data from the TriNetX Research Network. Author Contributions: Ali Seifi: Concept and study design, methodology development, writing – original draft, writing – review and editing, supervision Travis Kotzur: Data analysis, writing – original draft, writing – review and editing Arash Salardini: Writing – review and editing, literature search Camila Guerrero Miranda: Writing – review and editing, literature search Manan Gupta: Writing – review and editing, literature search Zehra Yavuz: Writing – review and editing, literature search This manuscript complies with all instructions to authors The authorship requirements have been met and the final manuscript was approved by all authors This manuscript has not been published elsewhere and is not under consideration by another journal STROBE reporting checklist was used. References Rinkel GJE, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol. 2011;10(4):349–56. 10.1016/S1474-4422(11)70017-5 . Cahill J, Zhang JH. 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Vergouwen MDI, Vermeulen M, van Gijn J, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41(10):2391–5. 10.1161/STROKEAHA.110.589275 . Supplementary Files STROBEchecklist.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9285679","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618491551,"identity":"0e10296a-f0b3-4104-855c-e3dc715fd0ae","order_by":0,"name":"Ali Seifi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBAC+QbGhg8JFQwMBlABxgZCWgwOMDbOSDjDIEGCFqCiGYxtJGlhb25seDjvcJ05/+HHH34w2MhuOEBAi3zPwcaGxG2HJSxnpJlJ9jCkGRPUwnAjsf0BSIvBDR42Bh6Gw4mEtdx/CLRlDlDL+TPMH/8w/CdCyw1GoJYGoJYDOQzSPAwHCGsxOJPY2JBwLF1yw400M2kZg2TjmYS0yLcff9j4o8aa3+D84ccf31TYyfYRdBiapaQpHwWjYBSMglGAAwAAu9xLPB0AEYsAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-5010-5041","institution":"The University of Texas Health Science Center at San Antonio","correspondingAuthor":true,"prefix":"","firstName":"Ali","middleName":"","lastName":"Seifi","suffix":""},{"id":618491552,"identity":"e082ff50-4895-4ad4-b02f-940b817c976e","order_by":1,"name":"Arash Salardini","email":"","orcid":"","institution":"UTHSCSA: The University of Texas Health Science Center at San Antonio","correspondingAuthor":false,"prefix":"","firstName":"Arash","middleName":"","lastName":"Salardini","suffix":""},{"id":618491553,"identity":"0358ad90-2f25-4260-9810-e78fcac9f4b9","order_by":2,"name":"Camila Guerrero Miranda","email":"","orcid":"","institution":"UF: University of Florida","correspondingAuthor":false,"prefix":"","firstName":"Camila","middleName":"Guerrero","lastName":"Miranda","suffix":""},{"id":618491554,"identity":"d95672f4-8cd9-46ad-878f-6baa0075ec79","order_by":3,"name":"Travis Kotzur","email":"","orcid":"","institution":"UTHSCSA: The University of Texas Health Science Center at San Antonio","correspondingAuthor":false,"prefix":"","firstName":"Travis","middleName":"","lastName":"Kotzur","suffix":""},{"id":618491555,"identity":"d0aec50f-a911-438d-b2c4-5dc2572fd3a2","order_by":4,"name":"Manan Gupta","email":"","orcid":"","institution":"UTHSCSA: The University of Texas Health Science Center at San Antonio","correspondingAuthor":false,"prefix":"","firstName":"Manan","middleName":"","lastName":"Gupta","suffix":""},{"id":618491556,"identity":"a0280f5c-ce37-475e-9217-4eab1235ad12","order_by":5,"name":"Zehra Yavuz","email":"","orcid":"","institution":"Ankara City Hospital: Ankara Sehir Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Zehra","middleName":"","lastName":"Yavuz","suffix":""}],"badges":[],"createdAt":"2026-04-01 02:48:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9285679/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9285679/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106637328,"identity":"29fc2dc2-e03b-4a5f-8763-3b08b712938b","added_by":"auto","created_at":"2026-04-10 17:00:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1615158,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier analysis demonstrates the cumulative incidence of neuropsychiatric outcomes across cohorts. Comparing Subarachnoid Hemorrhage with DCI, SAH without DCI, and the Control group for a 5-year follow-up.\u003c/p\u003e\n\u003cp\u003e(HR: Hazard Ratio, SAH: Subarachnoid Hemorrhage, DCI: Delayed Cerebral Ischemia)\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9285679/v1/31df8661c2656b053abbd7f2.png"},{"id":109204980,"identity":"e54f2b08-cbc3-4600-8d69-147594b74789","added_by":"auto","created_at":"2026-05-13 15:03:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2389457,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9285679/v1/40548b0b-7fe2-448c-ac67-a2083c7b18bf.pdf"},{"id":106637329,"identity":"4ca12afb-72a6-4a33-9528-f6d0dbb438e4","added_by":"auto","created_at":"2026-04-10 17:00:55","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18395,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-9285679/v1/2f761cc4c04fa19e5514cc2f.docx"}],"financialInterests":"","formattedTitle":"Long-Term Neuropsychiatric Outcomes After Nontraumatic Subarachnoid Hemorrhage: The Critical Role of Delayed Cerebral Ischemia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSubarachnoid hemorrhage (SAH) accounts for about 5% of all strokes, but its effects on patients are extensive and chronic. Unlike other types of strokes that tend to happen in older patients, SAH often occurs at a younger age when people are working and raising families\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Because treatments have improved and more patients survive the initial bleed, there is a growing number of survivors living with long-term problems\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Many patients with good functional recovery after SAH still experience subtle cognitive symptoms that interfere with returning to their previous lives. A systematic review of 65 studies involving 6,832 patients found that 40%\u0026ndash;70% of SAH survivors have measurable cognitive impairments\u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAbout 30% of patients who survive the early period go on to develop delayed cerebral ischemia\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. DCI involves problems in small blood vessels, microclots, abnormal cortical spreading depolarizations, and inflammation. All these things together reduce blood flow and damage brain tissue \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Several clinical trials, especially the CONSCIOUS studies, showed that treating vasospasm alone did not improve overall patient outcomes \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This shifted attention to DCI itself as a key player in long-term recovery, as this population is more likely to die or have lasting neuropsychological outcomes \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Studies suggest that cognitive problems\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, memory trouble, difficulty with planning, focus, and attention often last for years. \u003csup\u003e3,15\u003c/sup\u003e Mood problems are also frequent; approximately 30% of survivors deal with depression, and anxiety is just as common \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. These issues affect quality of life, work, and relationships, but they often get overlooked when clinicians only focus on whether someone can walk or care for themselves\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite growing awareness, we still lack large studies that look at the full range of neuropsychiatric problems after SAH and how DCI specifically contributes to them. Most research has focused either on cognition, mood or new onset seizures after SAH, and only a few studies have followed patients beyond the first year.\u003c/p\u003e \u003cp\u003eWith this in mind, we used a large national database with electronic health records to better understand the long-term neuropsychological outcomes of SAH. We aimed to answer three questions: First, how much higher are the risks of dementia, epilepsy, and mood disorders after SAH, compared to the control population? Second, does DCI further increase these risks among these patients? And third, how do these risks evolve over time? We hypothesized that nontraumatic SAH survivors would have higher rates of neuropsychiatric complications than the control population, and that those who had DCI would be worse.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective cohort study was performed using the TriNetX Research Network, a federated, multi-institutional database containing de-identified electronic health record data from academic and community health systems. The database includes patient demographics, diagnoses, procedures, medications, laboratory values, and longitudinal clinical outcomes and is compliant with HIPAA regulations. Our institution\u0026rsquo;s Institutional Review Board exempted this study from full review.\u003c/p\u003e \u003cp\u003eAdult patients with nontraumatic subarachnoid hemorrhage (SAH) were identified using ICD-10-CM diagnosis codes for \u0026ldquo;nontraumatic\u0026rdquo; SAH (I60), hereafter referred to as SAH. To ensure a complete five-year follow-up period, patients were included only if their index diagnosis occurred between January 1, 2013 and December 31, 2020. All included patients were then followed longitudinally for up to five years after the index event, with outcomes captured through 2025. Delayed cerebral ischemia (DCI) was defined using proxy ICD-10-CM codes for cerebral ischemia (I67.82) and cerebral vasospasm/vasoconstriction (I67.84) occurring during the index hospitalization period.\u003c/p\u003e \u003cp\u003eTo evaluate incident neuropsychiatric outcomes, patients with preexisting diagnoses of dementia, epilepsy, mood disorders, psychotic disorders, or related conditions prior to index SAH were excluded using ICD-10-CM codes for depressive episodes (F32), recurrent major depressive disorder (F33), vascular dementia (F01), dementia in other diseases (F02), unspecified dementia (F03), Alzheimer\u0026rsquo;s disease (G30), epilepsy/recurrent seizures (G40), schizophrenia (F20), bipolar disorder (F31), adjustment disorders (F43), unspecified psychosis (F29), anxiety disorders (F41), and mild cognitive impairment (G31.84). Coil embolization (CPT: 61624 and 61626) or surgical clipping (CPT: 61697, 61698, 61700, and 61702) were analyzed as treatment modalities to assess their association with outcomes in SAH.\u003c/p\u003e \u003cp\u003eThree comparisons were performed: (1) SAH versus a matched global control cohort, (2) SAH with DCI versus SAH without DCI, and (3) SAH with DCI versus matched controls. The control cohort consisted of a randomly selected population of patients with at least one ambulatory visit during the study period and no history of SAH.\u003c/p\u003e \u003cp\u003eTo reduce confounding, 1:1 propensity score matching (PSM) was performed using nearest-neighbor matching with a caliper of 0.1 pooled standard deviations. Matching covariates included age, sex, race, ethnicity, body mass index (BMI), hypertension, type 2 diabetes mellitus, ischemic heart disease, heart failure, chronic kidney disease, chronic lung disease, peripheral vascular disease, liver disease, and nicotine dependence. Patients who could not be matched were excluded from analysis, and minor differences in sample sizes across comparisons reflect cases excluded during propensity matching. Covariate balance was assessed using standardized mean differences (SMD), with values\u0026thinsp;\u0026lt;\u0026thinsp;0.10 considered acceptable.\u003c/p\u003e \u003cp\u003ePrimary outcomes included incident neuropsychiatric diagnoses following SAH, including composite dementia, Alzheimer\u0026rsquo;s disease, vascular dementia, epilepsy/recurrent seizures, mood/anxiety disorders (composite), depression, anxiety disorders, and bipolar disorder. Composite dementia was defined as any diagnosis of Alzheimer\u0026rsquo;s disease, vascular dementia, dementia in other diseases classified elsewhere, or unspecified dementia. Composite mood/anxiety outcomes included depressive disorders, anxiety disorders, stress-related disorders, bipolar disorder, schizophrenia, and psychosis not otherwise specified. Cumulative incidence was assessed using Kaplan\u0026ndash;Meier methodology, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e\n \u003cp\u003eA total of 73,007 patients with SAH were identified. After propensity matching, 72,976 matched pairs were included in the SAH versus control comparison. Patients with SAH had a mean age of 56.5 ± 20.8 years and were 47.2% female. Following matching, all demographic and clinical covariates were well balanced with standardized mean differences below 0.10 across all variables (Table 1).\u003c/p\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSubarachnoid Hemorrhage vs Control Demographics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSAH (n = 73,007)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eGlobal Cohort (n = 4,479,343)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eSMD (Before)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eSAH (n = 72,976)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eGlobal Cohort (n = 72,976)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eSMD (After)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e56.5 ± 20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e53.3 ± 14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e56.5 ± 20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e58.3 ± 15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 18–55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e29,404 (40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,337,348 (52.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e29,404 (40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e29,352 (40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 55–65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e14,917 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1,043,620 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e14,917 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e14,919 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 65–80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e18,977 (26.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1,004,794 (22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e18,977 (26.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e19,018 (26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge ≥ 80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e9,709 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e93,581 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e9,678 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e9,687 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite race\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e46,992 (64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,311,907 (51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e46,966 (64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e46,979 (64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e34,439 (47.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,556,380 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e34,430 (47.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e34,350 (47.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHispanic ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5,575 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e111,838 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e5,568 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e5,629 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, kg/m²\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e27.46 ± 6.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e30.24 ± 7.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e27.47 ± 6.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e28.37 ± 6.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI ≤ 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13,979 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e327,985 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e13,949 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e13,872 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI 30–35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4,531 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e159,473 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e4,524 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e4,496 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI ≥ 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2,797 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e135,520 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2,794 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e2,711 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e11,780 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e318,605 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e11,755 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e11,781 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 2 diabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4,553 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e137,063 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e4,542 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e4,506 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eIschemic heart disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4,461 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e77,534 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e4,434 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e4,395 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeripheral vascular disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3,349 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e43,218 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3,323 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e3,328 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic lung disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2,903 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e82,495 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2,889 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e2,862 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eNicotine dependence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2,700 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e52,549 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2,691 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e2,726 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic kidney disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2,572 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e50,504 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2,559 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e2,303 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart failure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2,466 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e27,973 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2,437 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e2,347 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e931 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e15,445 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e923 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e864 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eAbbreviations: SAH = subarachnoid hemorrhage; SMD = standardized mean difference; BMI = body mass index\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Baseline Demographic and Clinical Characteristics of SAH Patients and Matched Controls Before and After Propensity Score Matching\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNote: Minor differences in sample sizes reflect cases excluded during propensity matching due to lack of suitable matches. SMD \u0026lt;0.10 indicates adequate balance after matching.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIn the DCI versus non-DCI SAH analysis, 5,301 matched pairs were included. Patients with DCI were slightly older than those without DCI (59.2 ± 16.5 vs 56.9 ± 20.0 years; SMD = 0.123), while all other baseline characteristics were well balanced after matching (all SMD \u0026lt; 0.05). Similarly, in the DCI versus matched control comparison (5,299 pairs), all baseline covariates demonstrated adequate balance after matching (all SMD \u0026lt; 0.10) (Tables 2 and 3).\u003c/p\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDelayed Cerebral Ischemia vs No Delayed Cerebral Ischemia Demographics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSAH w/ DCI (n = 5,301)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eSAH w/o DCI (n = 68,390)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eSMD (Before)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eSAH w/ DCI (n = 5,301)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eSAH w/o DCI (n = 5,301)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eSMD (After)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e59.2 ± 16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e56.4 ± 21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e59.2 ± 16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e56.9 ± 20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 18–55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2,055 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e27,583 (40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2,055 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e2,049 (38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 55–65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1,266 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e13,798 (20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1,266 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1,271 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 65–80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1,328 (25.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e17,840 (26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1,328 (25.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1,327 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge ≥ 80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e652 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e9,169 (13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e652 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e654 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite race\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3,458 (65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e43,980 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3,458 (65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e3,478 (65.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3,204 (60.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e31,683 (46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3,204 (60.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e3,213 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHispanic ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e504 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e5,124 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e504 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e490 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, kg/m²\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e27.71 ± 6.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e27.45 ± 6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e27.71 ± 6.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e27.62 ± 6.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI ≤ 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1,559 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e13,068 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1,559 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1,578 (29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI 30–35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e567 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4,214 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e567 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e577 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI ≥ 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e338 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,603 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e338 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e325 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1,676 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e10,924 (16.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1,676 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1,684 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 2 diabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e557 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4,243 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e557 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e545 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eIschemic heart disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e552 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4,146 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e552 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e549 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeripheral vascular disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e677 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3,057 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e677 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e657 (12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic lung disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e364 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,692 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e364 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e402 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eNicotine dependence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e397 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,510 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e397 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e392 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic kidney disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e285 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,412 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e285 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e324 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart failure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e331 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,292 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e331 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e324 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e99 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e883 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e99 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e83 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eAbbreviations: SAH = subarachnoid hemorrhage; DCI = delayed cerebral ischemia; SMD = standardized mean difference; BMI = body mass index\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Baseline Demographic and Clinical Characteristics of SAH Patients With and Without Delayed Cerebral Ischemia Before and After Propensity Score Matching\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNote: Minor differences in sample sizes reflect cases excluded during propensity matching. SMD \u0026lt;0.10 indicates adequate balance after matching.\u003c/p\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDelayed Cerebral Ischemia vs Control Demographics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSAH w/ DCI (n = 5,301)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eControl Cohort (n = 4,479,343)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eSMD (Before)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eSAH w/ DCI (n = 5,299)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eControl Cohort (n = 5,299)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eSMD (After)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e59.2 ± 16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e53.3 ± 14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e59.2 ± 16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e58.6 ± 15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 18–55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2,055 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,337,348 (52.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2,055 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e2,033 (38.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 55–65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1,266 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1,043,620 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1,266 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1,275 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge 65–80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1,328 (25.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1,004,794 (22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1,327 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1,334 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge ≥ 80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e652 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e93,581 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e651 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e657 (12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite race\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3,458 (65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,311,907 (51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3,457 (65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e3,460 (65.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3,204 (60.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2,556,380 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3,202 (60.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e3,207 (60.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHispanic ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e504 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e111,838 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e503 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e516 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, kg/m²\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e27.71 ± 6.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e30.24 ± 7.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e27.72 ± 6.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e28.29 ± 5.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI ≤ 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1,559 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e327,985 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1,557 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1,545 (29.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI 30–35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e567 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e159,473 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e567 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e569 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBMI ≥ 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e338 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e135,520 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e337 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e314 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1,676 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e318,605 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.652\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1,674 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e1,682 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 2 diabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e557 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e137,063 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e556 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e567 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eIschemic heart disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e552 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e77,534 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e551 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e554 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeripheral vascular disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e677 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e43,218 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e675 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e663 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic lung disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e364 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e82,495 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e363 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e354 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eNicotine dependence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e397 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e52,549 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e396 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e404 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic kidney disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e285 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e50,504 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e284 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e295 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart failure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e331 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e27,973 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e329 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e324 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e99 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e15,445 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e98 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e84 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eAbbreviations: SAH = subarachnoid hemorrhage; DCI = delayed cerebral ischemia; SMD = standardized mean difference; BMI = body mass index\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Baseline Demographic and Clinical Characteristics of SAH Patients With Delayed Cerebral Ischemia and Matched Controls Before and After Propensity Score Matching\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNote: Minor differences in sample sizes reflect cases excluded during propensity matching. All covariates achieved adequate balance after matching with SMD \u0026lt;0.10.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eNeuropsychiatric Outcomes\u003c/h3\u003e\n\u003cp\u003eIn the SAH versus matched control comparison, SAH was associated with significantly higher risks of all evaluated neuropsychiatric outcomes. Composite dementia occurred in 4.19% of SAH patients versus 1.04% of controls (RR 4.02 [, 95% CI (3.72–4.35), p \u0026lt; 0.0001]). SAH was also associated with increased risks of Alzheimer's disease (RR 2.16 [, 95% CI (1.82–2.57), p \u0026lt; 0.0001]), vascular dementia (RR 5.87 [, 95% CI (4.76–7.25), p \u0026lt; 0.0001]), epilepsy/recurrent seizures (RR 11.25 [, 95% CI (9.95–12.71), p \u0026lt; 0.0001]), mood/anxiety disorders (RR 1.66 [, 95% CI (1.60–1.72), p \u0026lt; 0.0001]), depression (RR 2.08 [, 95% CI (1.98–2.19), p \u0026lt; 0.0001]), anxiety disorders (RR 1.51 [, 95% CI (1.45–1.58), p \u0026lt; 0.0001]), and bipolar disorder (RR 1.56 [, 95% CI (1.29–1.88), p \u0026lt; 0.0001]) (Table 4).\u003c/p\u003e\n\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSubarachnoid Hemorrhage vs Control Outcomes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSAH (n = 73,001)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eControl (n = 73,001)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eRisk Difference (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eRisk Ratio (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eDementia (composite)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e3,057 (4.188%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e760 (1.041%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e3.147% (2.984%, 3.309%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e4.022 (3.718, 4.352)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlzheimer’s disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e413 (0.566%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e191 (0.262%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.304% (0.238%, 0.370%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2.162 (1.822, 2.566)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular dementia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e593 (0.812%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e101 (0.138%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.674% (0.603%, 0.744%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e5.871 (4.756, 7.249)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpilepsy / recurrent seizures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e3,104 (4.252%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e276 (0.378%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e3.874% (3.721%, 4.027%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e11.246 (9.948, 12.714)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eMood/anxiety (composite)\u003c/strong\u003e\u003csup\u003e†\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e7,622 (10.441%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e4,590 (6.288%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e4.153% (3.870%, 4.437%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.661 (1.603, 1.720)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e4,451 (6.097%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e2,142 (2.934%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e3.163% (2.951%, 3.375%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2.078 (1.976, 2.186)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e5,041 (6.905%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e3,332 (4.564%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e2.341% (2.103%, 2.579%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.513 (1.450, 1.579)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eBipolar disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e285 (0.390%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e183 (0.251%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.140% (0.082%, 0.198%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.557 (1.294, 1.875)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e* The composite dementia outcome was defined as the occurrence of any of the following dementia diagnoses: Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, unspecified dementia\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e† The composite mood/anxiety outcome was defined as the occurrence of any of the following diagnoses: depressive episode, major depressive disorder, other anxiety disorders, reaction to severe stress and adjustment disorders, bipolar disorder, schizophrenia, or unspecified psychosis not due to a substance or known physiological condition\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Risk of Neuropsychiatric Outcomes in SAH Patients Compared to Matched Controls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviation \u0026nbsp; Definition\u003c/p\u003e\n\u003cp\u003eSAH \u0026nbsp; \u0026nbsp;subarachnoid hemorrhage\u003c/p\u003e\n\u003cp\u003eRR \u0026nbsp; \u0026nbsp;risk ratio\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; confidence interval\u003c/p\u003e\n\u003cp\u003eNote: Composite dementia includes Alzheimer's disease, vascular dementia, dementia in other diseases classified elsewhere, and unspecified dementia. Composite mood/anxiety includes depressive disorders, anxiety disorders, stress-related disorders, bipolar disorder, schizophrenia, and unspecified psychosis.\u003c/p\u003e\n\u003cp\u003eAmong patients with SAH, those who developed DCI experienced significantly worse neuropsychiatric outcomes compared with matched SAH patients without DCI. Composite dementia occurred in 8.45% versus 4.85% (RR 1.74 [, 95% CI (1.50–2.02), p \u0026lt; 0.0001]). DCI was also associated with increased risks of vascular dementia (RR 2.12 [, 95% CI (1.52–2.94), p \u0026lt; 0.0001]), epilepsy/recurrent seizures (RR 2.04 [, 95% CI (1.75–2.38), p \u0026lt; 0.0001]), mood/anxiety disorders (RR 1.56 [, 95% CI (1.42–1.71), p \u0026lt; 0.0001]), depression (RR 1.67 [, 95% CI (1.48–1.89), p \u0026lt; 0.0001]), and anxiety disorders (RR 1.42 [, 95% CI (1.26–1.59), p \u0026lt; 0.0001]), while no significant differences were observed for Alzheimer's disease or bipolar disorder (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDelayed Cerebral Ischemia vs. No Delayed Cerebral Ischemia Outcomes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSAH w/ DCI (n = 5,301)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eSAH w/o DCI (n = 5,301)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eRisk Difference (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eRisk Ratio (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eDementia (composite)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e448 (8.451%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e257 (4.848%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e3.603% (2.657%, 4.549%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.743 (1.503, 2.022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlzheimer’s disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e51 (0.962%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e40 (0.755%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.208% (-0.144%, 0.559%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.275 (0.844, 1.925)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.2468\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular dementia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e110 (2.075%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e52 (0.981%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e1.094% (0.628%, 1.561%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2.115 (1.524, 2.936)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpilepsy / recurrent seizures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e474 (8.942%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e232 (4.377%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e4.565% (3.620%, 5.510%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2.043 (1.754, 2.379)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eMood/anxiety (composite)\u003c/strong\u003e\u003csup\u003e†\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e971 (18.317%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e623 (11.752%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e6.565% (5.210%, 7.920%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.559 (1.420, 1.711)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e632 (11.922%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e378 (7.131%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e4.792% (3.678%, 5.906%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.672 (1.480, 1.888)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e606 (11.432%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e428 (8.074%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e3.358% (2.230%, 4.486%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.416 (1.259, 1.593)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eBipolar disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e28 (0.528%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e19 (0.358%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.170% (-0.083%, 0.423%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1.474 (0.824, 2.636)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e0.1883\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e* The composite dementia outcome was defined as the occurrence of any of the following dementia diagnoses: Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, unspecified dementia\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e† The composite mood/anxiety outcome was defined as the occurrence of any of the following diagnoses: depressive episode, major depressive disorder, other anxiety disorders, reaction to severe stress and adjustment disorders, bipolar disorder, schizophrenia, or unspecified psychosis not due to a substance or known physiological condition\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Risk of Neuropsychiatric Outcomes in SAH Patients With DCI Compared to Matched SAH Patients Without DCI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviation\u0026nbsp; \u0026nbsp;Definition\u003c/p\u003e\n\u003cp\u003eSAH\u0026nbsp; \u0026nbsp; \u0026nbsp;subarachnoid hemorrhage\u003c/p\u003e\n\u003cp\u003eDCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;delayed cerebral ischemia\u003c/p\u003e\n\u003cp\u003eRR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;risk ratio\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;confidence interval\u003c/p\u003e\n\u003cp\u003eNote: Composite dementia and composite mood/anxiety definitions are identical to those in Table 4. No significant differences were observed for Alzheimer's disease or bipolar disorder.\u003c/p\u003e\n\u003cp\u003eWhen compared with matched controls, patients with DCI demonstrated markedly elevated risks across nearly all outcomes, including composite dementia (RR 6.98 [, 95% CI (5.39–9.05), p \u0026lt; 0.0001]), Alzheimer's disease (RR 5.10 [, 95% CI (2.59–10.03), p \u0026lt; 0.0001]), epilepsy/recurrent seizures (RR 18.92 [, 95% CI (12.68–28.24), p \u0026lt; 0.0001]), mood/anxiety disorders (RR 2.98 [, 95% CI (2.65–3.36), p \u0026lt; 0.0001]), depression (RR 3.89 [, 95% CI (3.29–4.60), p \u0026lt; 0.0001]), anxiety disorders (RR 2.60 [, 95% CI (2.25–3.01), p \u0026lt; 0.0001]), and bipolar disorder (RR 2.33 [, 95% CI (1.19–4.58), p = 0.011]) (Table 6).\u003c/p\u003e\n\u003cdiv\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 6\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDelayed Cerebral Ischemia vs. Control Outcomes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSAH w/ DCI (n = 5,297)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eControl (n = 5,297)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eRisk Difference (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eRisk Ratio (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eDementia (composite)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e447 (8.439%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e64 (1.208%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e7.231% (6.426%, 8.035%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e6.984 (5.390, 9.051)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlzheimer’s disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e51 (0.963%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e≤ 10 (0.189%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.774% (0.486%, 1.062%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e5.10 (2.592, 10.034)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular dementia**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpilepsy / recurrent seizures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e473 (8.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e25 (0.472%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e8.458% (7.668%, 9.247%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e18.92 (12.677, 28.237)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eMood/anxiety (composite)\u003c/strong\u003e\u003csup\u003e†\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e969 (18.293%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e325 (6.136%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e12.158% (10.932%, 13.383%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2.982 (2.645, 3.361)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e630 (11.894%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e162 (3.058%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e8.835% (7.848%, 9.823%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3.889 (3.286, 4.602)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e604 (11.403%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e232 (4.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e7.023% (6.005%, 8.041%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2.603 (2.249, 3.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eBipolar disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e28 (0.529%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e12 (0.227%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.302% (0.069%, 0.536%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e2.333 (1.188, 4.584)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.0113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e* The composite dementia outcome was defined as the occurrence of any of the following dementia diagnoses: Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, unspecified dementia\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e† The composite mood/anxiety outcome was defined as the occurrence of any of the following diagnoses: depressive episode, major depressive disorder, other anxiety disorders, reaction to severe stress and adjustment disorders, bipolar disorder, schizophrenia, or unspecified psychosis not due to a substance or known physiological condition\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e** Vascular Dementia was censored due to a low number of events in the control group.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Risk of Neuropsychiatric Outcomes in SAH Patients With DCI Compared to Matched Controls\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviation\u0026nbsp; \u0026nbsp;Definition\u003c/p\u003e\n\u003cp\u003eDCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;delayed cerebral ischemia\u003c/p\u003e\n\u003cp\u003eSAH\u0026nbsp; \u0026nbsp; \u0026nbsp;subarachnoid hemorrhage\u003c/p\u003e\n\u003cp\u003eRR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;risk ratio\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;confidence interval\u003c/p\u003e\n\u003cp\u003eNote: Vascular dementia was censored due to low event counts in the control group. Composite dementia and composite mood/anxiety definitions are identical to those in Table 4.\u003c/p\u003e\n\u003ch3\u003eTreatment Modality: Clipping versus Coiling\u003c/h3\u003e\n\u003cp\u003eAmong patients with SAH, those who underwent surgical clipping had higher risks of certain neuropsychiatric outcomes compared with propensity-matched patients who received endovascular coiling. The strongest association was observed in epilepsy and recurrent seizures, which were significantly more common in the clipping group, occurring in 10.67% versus 7.23% (RR 1.48 [, 95% CI (1.19–1.83), p \u0026lt; 0.001]). Composite dementia occurred in 5.62% of clipped patients versus 3.84% of coiled patients (RR 1.46 [, 95% CI (1.08–1.98), p = 0.013]). No statistically significant differences were observed between treatment modalities for vascular dementia (RR 1.31 [, 95% CI (0.64–2.68), p = 0.463]), mood/anxiety disorders (RR 1.09 [, 95% CI (0.94–1.26), p = 0.243]), depression (RR 1.01 [, 95% CI (0.82–1.23), p = 0.955]), or anxiety disorders (RR 1.17 [, 95% CI (0.97–1.42), p = 0.095]). Outcomes for Alzheimer's disease and bipolar disorder could not be assessed due to low event counts (Table 7).\u003c/p\u003e\n\u003cdiv\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 7\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSurgical Clipping vs Endovascular Coiling Outcomes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSAH Clipping (n = 1,743)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eSAH Coil (n = 1,743)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eRisk Difference (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eRisk Ratio (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eDementia (composite)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e98 (5.622%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e67 (3.844%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e1.779% (0.37%, 3.187%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.463 (1.08, 1.981)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0134\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAlzheimer’s disease**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eVascular dementia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e17 (0.975%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e13 (0.746%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.229% (-0.384%, 0.843%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.308 (0.637, 2.684)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.4633\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eEpilepsy / recurrent seizures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e186 (10.671%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e126 (7.229%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e3.442% (1.55%, 5.334%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.476 (1.189, 1.832)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMood/anxiety (composite)†\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e312 (17.900%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e286 (16.408%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e1.492% (-1.011%, 3.994%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.091 (0.943, 1.262)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.2428\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e173 (9.925%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e172 (9.868%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e0.057% (-1.925%, 2.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.006 (0.823, 1.229)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.9548\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAnxiety disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e209 (11.991%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e178 (10.212%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e1.779% (-0.306%, 3.863%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.174 (0.972, 1.418)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e0.0947\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBipolar disorder**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e* The composite dementia outcome was defined as the occurrence of any of the following dementia diagnoses: Alzheimer’s disease, vascular dementia, dementia in other diseases classified elsewhere, unspecified dementia\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e† The composite mood/anxiety outcome was defined as the occurrence of any of the following diagnoses: depressive episode, major depressive disorder, other anxiety disorders, reaction to severe stress and adjustment disorders, bipolar disorder, schizophrenia, or unspecified psychosis not due to a substance or known physiological condition\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e** Detailed TriNetX results were not displayed because of low event counts.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Risk of Neuropsychiatric Outcomes in SAH Patients Treated with Surgical Clipping Compared to Endovascular Coiling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviation\u0026nbsp; \u0026nbsp;Definition\u003c/p\u003e\n\u003cp\u003eSAH\u0026nbsp; \u0026nbsp; \u0026nbsp;subarachnoid hemorrhage\u003c/p\u003e\n\u003cp\u003eRR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;risk ratio\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;confidence interval\u003c/p\u003e\n\u003cp\u003eNote: Outcomes for Alzheimer's disease and bipolar disorder could not be assessed due to low event counts. Composite dementia and composite mood/anxiety definitions are identical to those in Table 4.\u003c/p\u003e\n\u003ch3\u003eCumulative Incidence Modeling\u003c/h3\u003e\n\u003cp\u003eKaplan–Meier analysis demonstrated progressively higher cumulative incidence of neuropsychiatric outcomes across cohorts. The cumulative event probability was highest in the SAH with DCI group (37.52%), followed by SAH without DCI (26.45%), and lowest in the control cohort (11.39%). Compared with controls, both SAH without DCI (HR 2.95, 95% CI 2.86–3.05, p \u0026lt; 0.001) and SAH with DCI (HR 4.97, 95% CI 4.44–5.55, p \u0026lt; 0.001) were associated with significantly increased risk (Fig. 1).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study shows that SAH is associated significantly with elevated long-term risks of neuropsychiatric sequelae over five years of follow-up. Compared to the control, SAH patients had four-fold increased risk of composite dementia, an eleven-fold increased risk of epilepsy, and a two-fold increased risk of depression. Among those who developed DCI, outcomes were even worse: a seven-fold increased risk of dementia, an eighteen-fold risk of epilepsy, and a three-fold risk of mood/anxiety disorders compared to matched controls.\u003c/p\u003e\n\u003ch3\u003eDCI and Cognitive Decline\u003c/h3\u003e\n\u003cp\u003eOur findings support and substantially extend prior smaller studies \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24 CR25 CR26\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Stienen et al.\u003csup\u003e19\u003c/sup\u003e reported that DCI patients faced a nearly five-fold increased risk of moderate-to-severe neuropsychological deficits, while Springer et al.\u003csup\u003e20\u003c/sup\u003e, found that global cognitive impairment at one year post-SAH was 3.6 times more frequent in DCI patients and adversely affected functional recovery and quality of life. With over 5,000 matched pairs in our DCI versus non-DCI analysis, we now provide robust evidence that this association extends to formal dementia diagnoses, particularly vascular dementia, and that the risk continues to accrue over five years, supporting the concept that DCI triggers an ongoing, cumulative neurodegenerative process rather than a static insult \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24 CR25 CR26\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. From a psychiatric perspective, post-SAH cognitive impairment frequently presents with prominent executive dysfunction and frontal\u0026ndash;subcortical features that may overlap with or be amplified by mood symptoms. This overlap underscores the need for integrated neuropsychological and psychiatric evaluation to distinguish primary neurodegenerative processes from reversible contributors, such as depression (pseudodementia) or anxiety-related inattention.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Biologically, this progression can be explained by DCI-induced scattered microinfarcts through vasospasm, microthrombosis, cortical spreading depolarizations, and neuroinflammation, which accumulate over time and progressively impair cognitive function \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24 CR25 CR26\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Our observation of a divergence between DCI and non-DCI patients over five years aligns with the temporal patterns reported by Wenneberg et al.\u003csup\u003e3\u003c/sup\u003e and Walter et al.\u003csup\u003e21\u003c/sup\u003e, who noted that DCI-related deficits emerge at 2\u0026ndash;3 years but were preserved during the first year, and by Olsen et al.\u003csup\u003e22\u003c/sup\u003e, who demonstrated excess mortality over four years. Stienen et al.\u003csup\u003e23\u003c/sup\u003e further provided prospective evidence that DCI independently contributes to neuropsychological deterioration by using serial MoCA assessments before and after the DCI period, and Eagles et al.\u003csup\u003e14\u003c/sup\u003e confirmed this association using the CONSCIOUS-1 dataset\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan additionalcitationids=\"CR20 CR21 CR22\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. The underlying mechanisms are increasingly evolving. Neuroinflammation plays a central role, with elevated cerebrospinal fluid levels of IL-1β, TNF-α, and IL-6 observed in patients with poor outcomes\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. These mediators may persist chronically, promoting ongoing neurodegeneration. Additional contributors include hemosiderin deposition from superficial siderosis, hydrocephalus, and microvascular dysfunction\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Given these pathways, early therapeutic interventions, such as anti-inflammatory agents, iron chelation, or antithrombotic therapy, warrant investigation as potential strategies to mitigate DCI-related cognitive decline\u003csup\u003e\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eEpilepsy After SAH and DCI\u003c/h3\u003e\n\u003cp\u003eOur study demonstrates a very high risk of epilepsy following SAH, with SAH patients exhibiting an eleven-fold increased incidence compared to matched controls, further amplified to an eighteen-fold increase among those with DCI, which is consistent with previous studies documenting that seizures and epilepsy are increased after SAH\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The pathogenesis is likely multifactorial; direct cortical injury from the initial hemorrhage, epileptogenic effects of hemosiderin deposition due to superficial siderosis, and ischemic damage from DCI, all of which may create cortical irritability and seizure foci\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Huttunen, et al. identified several risk factors for post-SAH epilepsy, including early seizures, severe hemorrhage, and middle cerebral artery aneurysms\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Our findings add DCI to that list as a contributor, aligned with other studies that show DCI is an independent risk factor for seizures after SAH\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. The 2023 AHA/ASA guideline does not recommend routine antiseizure prophylaxis and provides no specific duration for high-risk patients, including those with DCI-related cortical infarction; the 7-day recommendation applies only to patients with new-onset seizures, not to those receiving prophylaxis\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. However, the near nineteen-fold higher rate of seizure among SAH patients with DCI in our five-year cohort underscores the need for prospective randomized trials regarding seizure prophylaxis and potentially targeted treatment in this high-risk subgroup.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMood Disorders\u003c/h2\u003e \u003cp\u003ePsychiatric morbidities were common in our cohort. Patients with SAH, particularly those with DCI, had a significantly higher risk of depression, mood/anxiety (composite) and anxiety disorders as compared to the control group. In a meta-analysis by Tang et al., which included 35 studies and 5,217 patients, the reported prevalence of depression after SAH ranged from 0% to 61.7%, with a pooled prevalence of 28.1%. Depression was assessed between 4 days and 10.1 years after ictus, with pooled prevalences of 32.2% within the first year and 27.3% beyond one year following the hemorrhage\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The near four-fold increase in risk we found in depression is meaningful and matches what others have found. In a smaller study of 226 SAH patients, Stienen, et al reported a five-fold increase in moderate-to-severe neuropsychological problems after DCI\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Impact of SAH and DCI on the patients\u0026rsquo; mood is more likely multifactorial. Damage to brain circuits involved in emotions, particularly in the frontal and limbic areas, could play a role. Moreover, going through a life-threatening event, dealing with new cognitive limits, and struggling to return to work or normal life all take an emotional toll\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Mood disorders in SAH survivors frequently involve a bidirectional relationship with cognitive deficits, depression and anxiety can worsen perceived cognitive impairment and reduce rehabilitation engagement, while residual brain injury may contribute to persistent emotional dysregulation. This cycle is well-documented in post-SAH literature and amenable to psychiatric intervention.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e The fact that DCI patients had higher rates of mood problems even after matching for other health issues suggests that the extra brain injury from ischemia adds to the burden.\u003c/p\u003e \u003cp\u003eIn a translational SAH animal model, delayed depression and memory impairment were observed and associated with disruption of astrocytic glutamate transporter-1 (GLT-1)\u0026ndash;mediated glutamate homeostasis. The study demonstrated that histone deacetylase-2 (HDAC2) regulates GLT-1 transcription, contributing to the development of delayed cognitive impairment after SAH. These findings also suggest that HDAC2 inhibitors may represent a potential therapeutic strategy for cognitive dysfunction following SAH\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Routine psychiatric screening in follow-up clinics (e.g., PHQ-9, GAD-7), coupled with early initiation of evidence-based treatments such as SSRIs and brief, tailored cognitive-behavioral therapy, may improve outcomes and quality of life in SAH survivors.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e These strategies should be incorporated into standard multidisciplinary care pathways.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Modality: Coil vs Clipping\u003c/h2\u003e \u003cp\u003eOur study demonstrates that among patients with SAH, those treated with surgical clipping had significantly higher long-term risks of neuropsychiatric complications compared to those who underwent endovascular coiling. Clipped patients experienced higher rates of composite dementia and epilepsy, while no significant differences were observed between treatment modalities for mood and anxiety disorders. These findings align with the International Subarachnoid Aneurysm Trial (ISAT), which reported better cognitive outcomes and lower seizure rates in coiled patients at one and five years\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Similarly, Latimer, et al. found that coiled patients had superior global cognitive performance, including higher IQ and better memory function\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. The mechanisms underlying these differences likely relate to the inherent nature of surgical clipping, which requires craniotomy and brain retraction, particularly of the frontal and temporal lobes, potentially causing direct cortical injury, gliosis, and subsequent epileptogenesis. Endovascular coiling, by contrast, avoids these mechanical insults to the brain parenchyma\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Notably, mood and anxiety disorders were similarly distributed between treatment groups. This suggests that the psychological burden of SAH may be driven predominantly by disease-related factors, including the existential impact of a life-threatening event and chronic cognitive impairment, rather than the specific treatment approach\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. This finding suggests that while surgical clipping confers a greater risk of dementia and epilepsy, all survivors warrant longitudinal comprehensive neuropsychiatric surveillance regardless of treatment modality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCumulative Incidence:\u003c/h2\u003e \u003cp\u003eKaplan-Meier analysis revealed a progressive gradient of neuropsychiatric risk across cohorts over five years of follow-up. Patients with SAH who developed DCI exhibited the poorest outcomes, with a 37.5% cumulative probability of developing a neuropsychiatric condition, compared to 26.45% among SAH patients without DCI. The progressively diverging survival curves during five years indicate that the neuropsychiatric sequelae of SAH, particularly DCI, represent ongoing, cumulative processes rather than static deficits, with the adverse impact becoming increasingly apparent over time. This temporal pattern aligns with prior studies: Wenneberg et al. observed that DCI-related deficits emerged at three years but not at one year; Olsen et al. demonstrated excess mortality over four years; and Stienen et al. documented persistent neuropsychological decline from baseline through three months post-SAH\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Critically, our five-year follow-up extends these observations by demonstrating that the gap between DCI and non-DCI patients continues to widen beyond previously reported time points; a novel finding indicates that DCI triggers progressive, cumulative neuropsychiatric decline rather than an isolated early injury\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. These results underscore the necessity of prolonged, structured neuropsychiatric surveillance for SAH survivors, particularly those who experience DCI (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eSAH survivors require surveillance beyond angiographic follow-up, including routine assessment for cognitive deficits, mood disturbances, and seizures, as functional scales may underestimate impairment\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. DCI should be recognized as a marker of elevated long-term neuropsychiatric risk, given that deficits may not manifest for a year or more\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. These data support multidisciplinary care models incorporating neuropsychology, stroke nursing, and rehabilitation medicine\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, as well as mental health interventions including SSRIs, cognitive-behavioral therapy, and potentially HDAC2 inhibitors\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Finally, clinical trials should incorporate standardized cognitive and mood assessments to capture treatment effects missed by mortality or functional outcomes alone\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations worth keeping in mind. We used administrative data and diagnosis codes, which can lead to misclassification or undercounting of outcomes. Mild cognitive problems and subtle mood changes often do not receive formal diagnoses in routine care, suggesting possible underestimation of the true rates. Defining DCI by reported codes is imperfect; these codes are a proxy for DCI and don't map exactly onto the Vergouwen consensus definition.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e We could not apply the strict clinical criteria that prospective studies use. Additionally, despite propensity matching, we cannot rule out residual confounding. We lacked information on variables, such as education level, socioeconomic status, severity of the initial bleed, or details about aneurysm location and treatment type. We were also unable to grade hemorrhage severity using scales such as Fisher scale, and we could not measure how severe the neuropsychiatric outcomes were. Dementia code does not distinguish between someone with mild forgetfulness or requiring fulltime care. Finally, this is an observational study, thus we cannot prove that SAH causes these outcomes, only that they are strongly linked. Despite these limitations, the large sample size, prolonged 5-years of follow-up, careful matching, multiple comparison groups, and time-to-event analysis allow us to provide robust estimates of the long-term neuropsychiatric burden of SAH and the specific contribution of DCI.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis large study of SAH survivors with a five-year follow-up quantifies the substantial long-term neuropsychiatric burden of SAH and establishes DCI as a driver of progressive, cumulative decline. SAH patients faced a four-fold higher risk of dementia and eleven-fold higher risk of epilepsy than matched controls, with DCI amplifying these risks to seven-fold and eighteen-fold, respectively, representing the largest risk magnitudes reported to date. Unlike prior studies with a shorter follow-up, we demonstrate that the gap between DCI and non-DCI patients continues to widen over five years, indicating that DCI triggers ongoing neurodegeneration rather than static injury. Surgical clipping independently increased dementia and epilepsy risks compared to coiling over an extended follow-up. These results reframe SAH as a chronic condition with progressive brain health consequences, necessitating long-term multidisciplinary surveillance. Future clinical trials must incorporate neuropsychiatric outcomes to fully capture treatment efficacy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eDisclosures:\u003c/p\u003e\n\u003cp\u003eThe authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.\u003c/p\u003e\n\n\u003cp\u003eSources of Funding:\u003c/p\u003e\n\u003cp\u003eThis study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\n\u003cp\u003ePrevious Presentations:\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\n\u003cp\u003eAcknowledgments:\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\n\u003cp\u003eEthics Approval:\u003c/p\u003e\n\u003cp\u003eThis study was deemed exempt from full review by the Institutional Review Board of the University of Texas Health San Antonio due to the use of de-identified data from the TriNetX Research Network.\u003c/p\u003e\n\n\u003cp\u003eAuthor Contributions:\u003c/p\u003e\n\n\u003cp\u003eAli Seifi: Concept and study design, methodology development, writing \u0026ndash; original draft, writing \u0026ndash; review and editing, supervision\u003c/p\u003e\n\n\u003cp\u003eTravis Kotzur: Data analysis, writing \u0026ndash; original draft, writing \u0026ndash; review and editing\u003c/p\u003e\n\n\u003cp\u003eArash Salardini: Writing \u0026ndash; review and editing, literature search\u003c/p\u003e\n\n\u003cp\u003eCamila Guerrero Miranda: Writing \u0026ndash; review and editing, literature search\u003c/p\u003e\n\n\u003cp\u003eManan Gupta: Writing \u0026ndash; review and editing, literature search\u003c/p\u003e\n\n\u003cp\u003eZehra Yavuz: Writing \u0026ndash; review and editing, literature search\u003c/p\u003e\n\n\u003cp\u003eThis manuscript complies with all instructions to authors\u003c/p\u003e\n\u003cp\u003eThe authorship requirements have been met and the final manuscript was approved by all authors\u003c/p\u003e\n\u003cp\u003eThis manuscript has not been published elsewhere and is not under consideration by another journal\u003c/p\u003e\n\u003cp\u003eSTROBE reporting checklist was used.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRinkel GJE, Algra A. 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Stroke. 2010;41(10):2391\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/STROKEAHA.110.589275\u003c/span\u003e\u003cspan address=\"10.1161/STROKEAHA.110.589275\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Subarachnoid Hemorrhage, Delayed Cerebral Ischemia, Dementia, Seizures, Mood Disorders, Surgical Clipping, Endovascular Coiling, Neuropsychiatry","lastPublishedDoi":"10.21203/rs.3.rs-9285679/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9285679/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNontraumatic subarachnoid hemorrhage (SAH) often affects young adults, and survivors face long-term neuropsychiatric problems. We sought to determine the rate of neuropsychiatric outcomes and the impact of delayed cerebral ischemia (DCI) on these sequels.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eRetrospective cohort study using TriNetX with five years follow up within 2013\u0026ndash;2020. Adults with nontraumatic SAH were identified and propensity score matching was used across SAH without DCI, SAH with DCI, versus matched controls.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 73,007 patients, those with SAH had a significantly increased risk of epilepsy (RR 11.25 [95% CI 9.95\u0026ndash;12.71], p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and composite dementia (RR 4.02 [95% CI 3.72\u0026ndash;4.35], p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) compared to controls. DCI was associated with elevated risks of epilepsy (RR 18.92 [95% CI 12.68\u0026ndash;28.24], p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and composite dementia (RR 6.98 [95% CI 5.39\u0026ndash;9.05], p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) versus controls. Clipping was associated with higher epilepsy (RR 1.48 [95% CI 1.19\u0026ndash;1.83], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and dementia (RR 1.46 [95% CI 1.08\u0026ndash;1.98], p\u0026thinsp;=\u0026thinsp;0.013) compared to coiling. Survival analysis demonstrated worse neuropsychiatric event-free survival among SAH patients with DCI (HR 4.97 [95% CI 4.44\u0026ndash;5.55], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to controls.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings demonstrate that SAH, particularly when complicated by DCI, is associated with substantially increased long-term risks of epilepsy and dementia, with clipping conferring additional epilepsy risk.\u003c/p\u003e","manuscriptTitle":"Long-Term Neuropsychiatric Outcomes After Nontraumatic Subarachnoid Hemorrhage: The Critical Role of Delayed Cerebral Ischemia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-10 17:00:52","doi":"10.21203/rs.3.rs-9285679/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b6099c9-d7f1-467f-9811-f150cc64ca9d","owner":[],"postedDate":"April 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T14:36:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-10 17:00:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9285679","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9285679","identity":"rs-9285679","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}