Prognostic factors in AAA rupture

Good outcome

  • Preoperative serum creatinine <130mmol/L
  • Evidence of good preoperative urine output
  • Presence of infra-renal aneurysm (rather than supra- or junta-renal)
  • Lack of cardiorespiratory comorbidities

Bad outcome

  • Preoperative comorbidities e.g. chronic renal failure, ischaemic heart disease, COPD
  • Intraperitoneal rupture
  • Persistent preoperative hypotension i.e. systolic BP <90mmHg
  • Evidence of multi-organ failure

Hardman Index

Based on retrospective study of 154 patients (1996).
Identified five variables associated with poor outcome:

  • Age >76 years
  • Ischaemic ECG
  • Creatinine >190mmol/L
  • Low GCS
  • Hb <9g/d.

If >3 variables present mortality was found to be 100%.

A subsequent retrospective review of 114 patients (2006) found an 81% mortality rate with a Hardman Index of 2 or above.

Glasgow Aneurysm Score

Simple risk calculation tool where the age of the patient is added to the number of points they score based on the following:

  • 17 points: Presence of shock
  • 7 points: Presence of myocardial disease
  • 10 points: Presence of cerebrovascular disease
  • 14 points: Presence of renal disease

Based on retrospective review of 500 patients (1994). Also validated for use in elective patients.