Platelets-to-serum Ca2+ ratio as a risk factor for postoperative cerebral vasospasm in surgically treated aneurysmal subarachnoid hemorrhage patients.

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) generally requires surgical intervention to secure the aneurysm(s). Cerebral vasospasm (CVS) is a common complication of aSAH that occurs before and after a clipping or coiling procedure. However, we have limited options for the prevention or early detection of CVS by far. Although some biomarkers were studied regarding the purpose, some of which are rather complicated and actually hard to obtain. We conducted this study to investigate the potential correlations between the platelets-to-serum Ca2+ ratio (P/C) and the occurrence of postoperative CVS in aSAH patients. We enrolled 262 patients in this retrospective study, clinical features and lab results were collected from an electronic medical record (EMR) system. The variables were consecutively analyzed in univariate and multivariate analyses; p-values < 0.05 were considered significant. The predictive values of several certain variables for CVS were further assessed through receiver operating characteristic (ROC) analysis. The prevalence of CVS in our study was 33.6%. Patients suffering from CVS had significantly increased P/C levels compared to those who did not (p = 0.045). Multivariate logistic analysis revealed that P/C was independently associated with postoperative CVS (p = 0.041). ROC curves demonstrated prominent interactions between P/C and clinical rankings, in terms of predicting postoperative CVS in aSAH patients. At a cutoff value of 112.53, patients with higher P/C levels in the early stage of aSAH were more likely to develop symptomatic CVS after aneurysm occlusion (p = 0.004). Among aSAH patients, a higher P/C at admission increases the risk of postoperative CVS events and, with easy access, it may serve as a novel predictor for the complication.