Table 3.
Cox-regression analysis of the association of periodontitis and gingival bleeding at baseline with risk of later aneurysmal subarachnoid hemorrhage during follow-up
| Variable | Cases in each group/number of followed subjects in the model | Hazard ratio | 95%CI | p value |
|---|---|---|---|---|
| Model 1 | ||||
| Age | 2792 | 1.0 | 0.9–1.1 | 0.600 |
| Gender | ||||
| Male | 1602/2792 | 1 | ||
| Female | 1194/2792 | 4.5 | 0.8–25.5 | 0.090 |
| Hypertension | ||||
| No confirmed hypertension | 1673/2792 | 1 | ||
| Confirmed hypertension | 1123/2792 | 0.6 | 0.1–3.7 | 0.575 |
| Smoking status | ||||
| Non-smoking | 1345/2792 | 1 | ||
| Daily or intermittent smoking | 1451/2792 | 3.6 | 0.4–32.1 | 0.256 |
| Severe periodontitis# (≥ 6 mm periodontal pocket) | ||||
| 0–2 teeth affected | 2522/2792 | 1 | ||
| ≥ 3 teeth affected | 274/2792 | 22.5 | 3.6–139.5 | 0.001* |
| Model 2 | ||||
| Age | 2786 | 1.1 | 1.0–1.1 | 0.172 |
| Gender | ||||
| Male | 1598/2786 | 1 | ||
| Female | 1189/2786 | 3.5 | 0.6–19.6 | 0.157 |
| Hypertension | ||||
| No confirmed hypertension | 1668/2786 | 1 | ||
| Confirmed hypertension | 1119/2786 | 0.8 | 0.1–4.7 | 0.786 |
| Smoking status | ||||
| Non-smoking | 1340/2786 | 1 | ||
| Daily or intermittent smoking | 1447/2786 | 5.4 | 0.6–48.7 | 0.130 |
| Gingival bleeding¤ | ||||
| 0–4 sextants affected | 2170/2786 | 1 | ||
| 5–6 sextants affected | 617/2786 | 8.3 | 1.5–46.1 | 0.015* |
In a multivariate analysis that included periodontal probing depth and gingival bleeding as markers of past or ongoing periodontitis and gingival infection, active smoking at the beginning of the follow-up and gingival bleeding on probing were the only significant predictors of aneurysmal SAH during follow-up. The number of followed study participants (cases) with data available on all the included variables were 2792 (model 1) and 2783 (model 2), with 6 of these patients being diagnosed with aSAH during the 13-year follow-up and undergoing a surgical or endovascular procedure for the ruptured IA, thus confirming the diagnosis
Smoking status was categorized as daily or intermittent smoking, or non-smoking. Periodontitis was defined as presence of at least one tooth with ≥ 4 mm probing depth, and severe periodontitis# as the presence of a periodontal pocket ≥ 6 mm deep. Survey participants were categorized according to the number of affected teeth
Gingival bleeding¤ was defined as a number of tooth sextants in which bleeding occurred from the gingival margin on probing. Survey participants were categorized according to the number of affected sextants
Periodontal probing depth and gingival bleeding on probing were not included in the models simultaneously due to high intervariable correlation
Asterisks are statistically significant p values
#Also the extent of severe periodontitis as measured by the number of teeth with ≥ 6 mm periodontal pockets at baseline (continuous variable) associated with risk of aSAH (HR 1.2, 95%CI 1.1–1.4, p = 0.002)
¤Also the extent of gingival inflammation as measured by the number of sextants with bleeding on probing at baseline (continuous variable) associated with increased risk for aSAH (HR 1.7, 95%CI 1.1–2.5, p = 0.021)