Clinical outcomes and complication risks of aneurysmal subarachnoid hemorrhage (aSAH) in high-altitude regions: a retrospective study from Xizang.

Aneurysmal subarachnoid hemorrhage (aSAH) is a critical cerebrovascular emergency with high morbidity and mortality. High-altitude regions like Xizang, characterized by chronic hypobaric hypoxia, may present unique clinical features. However, there is still a lack of research data on the clinical manifestations and prognosis of aSAH in such Settings. We retrospectively analyzed 587 patients with radiologically confirmed aSAH admitted to the People’s Hospital of the Xizang Autonomous Region from December 2016 to September 2024. Baseline characteristics, aneurysm features, treatments, complications, and outcomes were collected. The primary outcome was discharge functional status measured by the modified Rankin Scale (mRS). Logistic regression was used to identify predictors of poor outcomes (mRS ≥ 3). The median age was 50 years, with 70.36% female patients. Most presented with good-grade aSAH (WFNS I–III, 91.14%). Endovascular coiling was used in 69.34% of cases, and surgical clipping in 30.66%. Clipping was associated with longer hospitalization (22 vs. 17 days, p < 0.0001) and higher rates of anemia, hypoproteinemia, and pneumonia. Poor outcomes (mRS ≥ 3) occurred in 24.02% overall, more frequently in the clipping group (31.11% vs. 20.88%, p = 0.0102). Hunt–Hess grade IV–V (OR 3.33, 95% CI: 1.75–6.34) and modified Fisher grade III–IV (OR 3.19, 95% CI: 2.05–4.96) were independent predictors of poor outcome. In this high-altitude cohort, coiling was associated with better short-term outcomes. Admission severity independently predicted prognosis, underscoring the need for altitude-specific strategies in managing aSAH.