Risk factors and predictive models of poor prognosis and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage complicated with hydrocephalus

Abstract

ObjectiveTo evaluate the correlation of serum biological markers and related scales to the occurrence of delayed cerebral ischemia and clinical prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH) complicated with acute hydrocephalus before admission.MethodsThe clinical data of 227 patients with pre-admission aSAH complicated with acute hydrocephalus admitted to Henan Provincial People's Hospital from April 2017 to December 2020 were retrospectively analyzed. Patients were grouped according to the presence or absence of delayed cerebral ischemia (DCI) after surgery and the prognosis at 6 months after discharge. Univariate and multivariable logistic regression analysis were performed to analyze the relationship between serum biological indicators combined with aneurysm related clinical score scale and the occurrence and prognosis of delayed cerebral ischemia. ROC curves and nomogram were drawn.ResultsMultivariable Logistic regression analysis showed that high Hunt-Hess grade and surgical clipping were independent risk factors for postoperative DCI (P < 0.05). Older age, higher Hunt-Hess grade, higher CRP and neutrophil levels were independent risk factors for poor prognosis at 6 months after surgery (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of Hunt-Hess grade and surgical method for predicting DCI in patients with aSAH combined with hydrocephalus after surgery were 0.665 and 0.593. The combined AUC of Hunt-Hess grade and surgical method was 0.685, the sensitivity was 64.9%, and the specificity was 64.7%. The AUC of CRP, neutrophil, age and Hunt-Hess grade for predicting poor prognosis in patients with aSAH combined with hydrocephalus at 6 months after surgery were 0.804, 0.735, 0.596, 0.757, respectively. The combined AUC of CRP, neutrophil, age, Hunt-Hess grade was 0.879, the sensitivity was 79%, and the specificity was 84.5%. According to the correction curve, the predicted probability of the nomogram is basically consistent with the actual probability.ConclusionHunt-Hess grade and surgical method are independent predictors of postoperative DCI in patients with aSAH complicated with hydrocephalus. “CRP,” “neutrophil,” “age” and “Hunt-Hess grade” at admission are independent predictors of clinical prognosis in patients with aSAH complicated with hydrocephalus. The combination of the above indicators has high predictive value.

Monitoring of Perioperative Microcirculation Dysfunction by Near-Infrared Spectroscopy for Neurological Deterioration and Prognosis of Aneurysmal Subarachnoid Hemorrhage: An Observational, Longitudinal Cohort Study

“…In the present study, the demographic and clinical manifestations were similar to those in previous studies [ 31 ]. Age was significantly associated with neurological deterioration among patients with aSAH.…”

HDL anti-inflammatory function is impaired and associated with high SAA1 and low APOA4 levels in aneurysmal subarachnoid hemorrhage

“…The mean TC and LDL in the patients were 162.3 mg/dl (95% CI: 139.2-185.3) and 77.59 mg/ dl (95% CI: 64.24-90.93), respectively, without differences from controls. The median GCS (interquartile range) at the time of presentation was 13 (9-15), while the median Hunt-Hess scale was 2 (2-3), the median Fisher grade was 4 (3-4), and the median WFNS was 2 (1)(2)(3)(4). The GOS at 6 months was 5 (3)(4)(5).…”

“…Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all types of stroke, has a mortality of 35%, and most survivors have long-term disabilities or cognitive dysfuntion. [1][2][3] The mechanisms of secondary brain injury after aSAH are multifactorial and start immediately after bleeding. Recent evidence shows that inflammation mediates many of the vascular and neural changes observed in the acute phase after aSAH (0-24 hours after hemorrhage).…”

A nomogram for predicting the risk of poor prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage following microsurgical clipping

“…The Hunt-Hess grading system, a simple and effective clinical grading scale for SAH, was designed to standardize the clinical assessment of SAH and facilitate patient management ( 24 ). Multiple studies have shown that the prognosis of patients with aSAH was significantly correlated with the Hunt-Hess grade ( 25 , 26 ). In addition, our results showed that the Hunt-Hess grade was a solid predictor of poor outcomes in patients with poor-grade aSAH who underwent microsurgical clipping.…”