Aneurysmal Subarachnoid Hemorrhage Patients Research Articles

An institutional report of heparin induced thrombocytopenia type II in aneurysmal subarachnoid hemorrhage patients.

Heparin induced thrombocytopenia Type II (HIT-II) is a dangerous thromboembolic complication of heparin therapy. The current literature on incidence and outcomes of HIT-II in aneurysmal subarachnoid hemorrhage (aSAH) patients remains sparse. We report our institution's incidence and outcomes of HIT-II in aSAH patients. We performed a retrospective cohort study at an academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography. Diagnosis of HIT-II was determined by positive results on both heparin PF4-platelet antibody ELISA (anti-PF4) and serotonin release assay (SRA). 204 patients met inclusion criteria. Seven patients (7/204, 3.5%) underwent laboratory testing, three of whom met clinical criteria. HIT-II incidence was confirmed in two of these seven patients (2/204, 0.98%), who had high BMI and T4 scores. Our institution's report of HIT-II incidence in aSAH patients is lower than previously reported in this population and more closely parallels HIT-II incidence in the general and surgical ICU setting. Widely-accepted American College of Chest Physicians (ACCP) clinical diagnostic criteria in conjunction with anti-PF4 and SRA testing is the gold standard of clinical diagnosis of HIT-II in aSAH patients.

Comparison between rupture/growth risk scores and treatment recommendation scores application to aneurysmal subarachnoid hemorrhage patients: A multicenter cross-reliability assessment study

BackgroundTwo score families were introduced to help clinicians about the decision-making regarding intracranial aneurysms management. The first family estimates the growth/rupture risk (GRS), whereas the second provides straightforward recommendation (RS) for treatment decisions. However, both remain poorly validated and little is known about their agreement. In this paper, we performed a retrospective concordance analysis among the two scores families through their application to a multicenter cohort of SAH patients. MethodsDemographical, clinical and radiological data were extracted in conformance with the variables included in PHASES, UCAS, ELAPSS, Juvela’s growth score (JGS), UIATS and Juvela’s treatment score (JTS). Individual patients’ score were calculated for both score families, and pooled data were then analyzed. ResultsOverall, 146 patients were included. True positive rates were: 51.4% for PHASES; 71.9% for UCAS; between 60.3% and 90.4% for JTS; and between 27.4% and 68.5% for UIATS.In patients showing UIATS unclear recommendation and low JTS score (RS), UCAS outperformed PHASES (GRS) in identifying aneurysms at higher risk of rupture. Same results we found for patients with conservative UIATS recommendation and very low JTS score. Forty-to-sixty percent of aneurysms with unclear or conservative RS recommendation would have been identified as at high risk with GRS. ConclusionsRetrospectively applied, JTS appeared outperforming UIATS in correctly recommending treatment in a higher percentage of patients. UIATS and JTS appeared agreeing more with UCAS than PHASES predictions. Around 50% of patients with unclear or conservative UIATS/JTS recommendations were been classified as at higher growth risk by ELAPSS and JGS.

Herniation World Federation of Neurosurgical Societies Scale Improves Prediction of Outcome in Patients With Poor-Grade Aneurysmal Subarachnoid Hemorrhage.

Favorable outcomes are seen in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) grade V aneurysmal subarachnoid hemorrhage. Therefore, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. We previously modified the WFNS scale by requiring positive signs of brain stem dysfunction to assign grade V. This study aimed to validate the new herniation WFNS grading system in an independent prospective cohort. We conducted an international prospective multicentre study in poor-grade aneurysmal subarachnoid hemorrhage patients comparing the WFNS classification with a modified version-the herniation WFNS scale (hWFNS). Here, only patients who showed positive signs of brain stem dysfunction (posturing, anisocoric, or bilateral dilated pupils) were assigned hWFNS grade V. Outcome was assessed by modified Rankin Scale score 6 months after hemorrhage. The primary end point was the difference in specificity of the WFNS and hWFNS grading with respect to poor outcomes (modified Rankin Scale score 4-6). Of the 250 patients included, 237 reached the primary end point. Comparing the WFNS and hWFNS scale after neurological resuscitation, the specificity to predict poor outcome increased from 0.19 (WFNS) to 0.93 (hWFNS) (McNemar, P<0.001) whereas the sensitivity decreased from 0.88 to 0.37 (P<0.001), and the positive predictive value from 61.9 to 88.3 (weighted generalized score statistic, P<0.001). For mortality, the specificity increased from 0.19 to 0.93 (McNemar, P<0.001), and the positive predictive value from 52.5 to 86.7 (weighted generalized score statistic, P<0.001). The identification of objective positive signs of brain stem dysfunction significantly improves the specificity and positive predictive value with respect to poor outcome in grade V patients. Therefore, a simple modification-presence of brain stem signs is required for grade V-should be added to the WFNS classification. URL: https://clinicaltrials.gov; Unique identifier: NCT02304328.

Diagnostic value of cerebral vasospasm by transcranial doppler ultrasound in Vietnamese patients with subarachnoid hemorrhage.

Although the application of transcranial Doppler (TCD) ultrasonography in clinical diagnosis of cerebral vasospasm is popular in clinical practice in Vietnam, available evidence of the predictive value of vasospasm on TCD in the literature was mostly reported from large institutions in developed countries. Hence, this study was conducted to evaluate the value of TCD ultrasonography in the diagnosis of vasospasm in patients with subarachnoid hemorrhage (SAH) in Vietnam. This is a prospective observational study of all aneurysmal SAH patients consecutively admitted to a single center between 2008 and December 2011. TCD and 64-slice computed tomographic angiography (CTA) were used to cerebral vasospasm in SAH patients. 316 patients were analyzed (mean age = 52.97±12.27 years, 52.2% males). There were statistically significant difference rates of the cerebral vasospasm by Hunt and Hess Classification and Fisher classification (p <0.01). The proportion of the patients with cerebral vasospasm who were diagnosed exactly by TCD was 95.2%, while the proportion of the patients without cerebral vasospasm diagnosed exactly was 91.5%. TCD predictive diagnostic value was the highest, with the sensitivity of 0.95 (95% CI: 0.91-0.98), specificity of 0.91 (95% CI: 0.85-0.96), positive predictive value of 0.94 (5% CI: 0.90-0.97) and negative predictive value of 0.93 (95 CI: 0.87-0.97). Hemiplegia was the clinical symptom with the highest diagnostic value with the sensitivity of 0.34 (95% CI: 0.27-0.41), specificity of 0.92 (95% CI: 0.86-0.96), positive predictive value of 0.86 (95% CI: 0.76-0.93) and negative predictive value of 0.49 (95% CI: 0.41-0.54). Evidence of vasospasm diagnosis on TCD ultrasonography was found with high accuracy. Current study enables to suggest the wide application of TCD in Vietnam health facilities from central to grassroots levels instead of the CTA use.

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

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.

Altered Expression of Specific MicroRNAs in Plasma of Aneurysmal Subarachnoid Hemorrhage Patients.

BackgroundAneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition with high disability and mortality. MicroRNAs (miRNAs) are reported to play a modulating role in aSAH. We investigated specific plasma microRNAs (miRNAs) associated with aSAH and gained comprehensive insight into its pathological mechanisms.MethodsThis is a prospective case–control study. We used a two-stage approach, with primary screening and ensuing two-step validation stages. Significantly differentially expressed plasma miRNAs between aSAH patients and neurologically healthy controls were initially screened by microarray analysis. These miRNAs were then validated in two groups of independent cohorts using reverse transcription quantitative real-time polymerase chain reaction assays. Functional annotation of these miRNA targets was performed by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses.ResultsIn the primary screening stage, 14 miRNAs were identified as differentially expressed at a significance level of P < 0.05 and fold change >2 between 5 aSAH patients and 5 neurologically healthy controls. In the two validation steps (20 patients vs. 20 control; 40 patients vs. 30 controls), miR-23b-3p, miR-590-5p, miR-20b-5p, miR-142-3p, and miR-29b-3p were found to be significantly down-regulated in patients with aSAH compared with controls. Through these 5 miRNAs, we obtained 32 overlapping target genes, including TGM2, EREG, EDN1, and COL4A1, in three databases that may affect the progression of aSAH. The results of functional annotation revealed mechanisms mainly related to inflammation, smooth muscle cell proliferation and cell adhesion, potentially contributing to the occurrence of aSAH.ConclusionWe demonstrate that specific miRNAs in plasma, including miR-23b-3p, miR-590-5p, miR-20b-5p, miR-142-3p, and miR-29b-3p, are significantly down-regulated in aSAH patients and may play a modulating role in its progression.

Utility of frailty as a predictor of acute kidney injury in patients with aneurysmal subarachnoid hemorrhage.

Acute kidney injury (AKI) is associated with poor outcome in aneurysmal subarachnoid hemorrhage patients (aSAH). Frailty has recently been demonstrated to correlate with elevated mortality and morbidity; its impact on predicting AKI and mortality in aSAH patients has not been investigated. Evaluating risk factors and predictors for AKI in aSAH patients. aSAH patients from a single-center's prospectively maintained database were retrospectively evaluated for development of AKI within 14 days of admission. Baseline demographic and clinical characteristics were collected. The effect of frailty and other risk factors were evaluated. Of 213 aSAH patients, 53 (33.1%) were frail and 12 (5.6%) developed AKI. Admission serum creatinine (sCr) and peak sCr within 48 h were higher in frail patients. AKI patients showed a trend towards higher frailty. Mortality was significantly higher in AKI than non-AKI aSAH patients. Frailty was a poor predictor of AKI when controlling for Hunt and Hess (HH) grade or age. HH grade ≥ 4 strongly predicted AKI when controlling for frailty. AKI in aSAH patients carries a poor prognosis. The HH grade appears to have superior utility as a predictor of AKI in aSAH patients than mFI.

Applying Quantitative Radiographic Image Markers to Predict Clinical Complications After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study.

Accurately predicting clinical outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients is difficult. The purpose of this study was to develop and test a new fully-automated computer-aided detection (CAD) scheme of brain computed tomography (CT) images to predict prognosis of aSAH patients. A retrospective dataset of 59 aSAH patients was assembled. Each patient had 2 sets of CT images acquired at admission and prior-to-discharge. CAD scheme was applied to segment intracranial brain regions into four subregions, namely, cerebrospinal fluid (CSF), white matter (WM), gray matter (GM), and leaked extraparenchymal blood (EPB), respectively. CAD then detects sulci and computes 9 image features related to 5 volumes of the segmented sulci, EPB, CSF, WM, and GM and 4 volumetrical ratios to sulci. Subsequently, applying a leave-one-case-out cross-validation method embedded with a principal component analysis (PCA) algorithm to generate optimal feature vector, 16 support vector machine (SVM) models were built using CT images acquired either at admission or prior-to-discharge to predict each of eight clinically relevant parameters commonly used to assess patients' prognosis. Finally, a receiver operating characteristics (ROC) method was used to evaluate SVM model performance. Areas under ROC curves of 16 SVM models range from 0.62 ± 0.07 to 0.86 ± 0.07. In general, SVM models trained using CT images acquired at admission yielded higher accuracy to predict short-term clinical outcomes, while SVM models trained using CT images acquired prior-to-discharge demonstrated higher accuracy in predicting long-term clinical outcomes. This study demonstrates feasibility to predict prognosis of aSAH patients using new quantitative image markers generated by SVM models.

Optimal Cerebral Perfusion Pressure During Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage.

The recommendation of induced hypertension for delayed cerebral ischemia treatment after aneurysmal subarachnoid hemorrhage has been challenged recently and ideal pressure targets are missing. A new concept advocates an individual cerebral perfusion pressure where cerebral autoregulation functions best to ensure optimal global perfusion. We characterized optimal cerebral perfusion pressure at time of delayed cerebral ischemia and tested the conformity of induced hypertension with this target value. Retrospective analysis of prospectively collected data. University hospital neurocritical care unit. Thirty-nine aneurysmal subarachnoid hemorrhage patients with invasive neuromonitoring (20 with delayed cerebral ischemia, 19 without delayed cerebral ischemia). Induced hypertension greater than 180 mm Hg systolic blood pressure. Changepoint analysis was used to calculate significant changes in cerebral perfusion pressure, optimal cerebral perfusion pressure, and the difference of cerebral perfusion pressure and optimal cerebral perfusion pressure 48 hours before delayed cerebral ischemia diagnosis. Optimal cerebral perfusion pressure increased 30 hours before the onset of delayed cerebral ischemia from 82.8 ± 12.5 to 86.3 ± 11.4 mm Hg (p < 0.05). Three hours before delayed cerebral ischemia, a changepoint was also found in the difference of cerebral perfusion pressure and optimal cerebral perfusion pressure (decrease from -0.2 ± 11.2 to -7.7 ± 7.6 mm Hg; p < 0.05) with a corresponding increase in pressure reactivity index (0.09 ± 0.33 to 0.19 ± 0.37; p < 0.05). Cerebral perfusion pressure at time of delayed cerebral ischemia was lower than in patients without delayed cerebral ischemia in a comparable time frame (cerebral perfusion pressure delayed cerebral ischemia 81.4 ± 8.3 mm Hg, no delayed cerebral ischemia 90.4 ± 10.5 mm Hg; p < 0.05). Inducing hypertension resulted in a cerebral perfusion pressure above optimal cerebral perfusion pressure (+12.4 ± 8.3 mm Hg; p < 0.0001). Treatment response (improvement of delayed cerebral ischemia: induced hypertension+ [n = 15] or progression of delayed cerebral ischemia: induced hypertension- [n = 5]) did not correlate to either absolute values of cerebral perfusion pressure or optimal cerebral perfusion pressure, nor the resulting difference (cerebral perfusion pressure [p = 0.69]; optimal cerebral perfusion pressure [p = 0.97]; and the difference of cerebral perfusion pressure and optimal cerebral perfusion pressure [p = 0.51]). At the time of delayed cerebral ischemia occurrence, there is a significant discrepancy between cerebral perfusion pressure and optimal cerebral perfusion pressure with worsening of autoregulation, implying inadequate but identifiable individual perfusion. Standardized induction of hypertension resulted in cerebral perfusion pressures that exceeded individual optimal cerebral perfusion pressure in delayed cerebral ischemia patients. The potential benefit of individual blood pressure management guided by autoregulation-based optimal cerebral perfusion pressure should be explored in future intervention studies.

Abstract WP139: Association Of Antiplatelet Use And Outcomes In Aneurysmal Subarachnoid Hemorrhage

Introduction: Antiplatelet agents are commonly used after endovascular repair of ruptured aneurysms in patients with subarachnoid hemorrhage (SAH). Recent evidence suggests post-treatment antiplatelets may reduce risk of delayed cerebral ischemia (DCI) and worse outcome. We sought to determine potential risks and benefits of antiplatelets in our patients’ population Methods: This is a retrospective cohort study of consecutive patients with aneurysmal SAH who were admitted to an academic referral center from 2016 to 2021. We used multivariable logistic regression analysis, propensity score matching and multiple linear regression to test the association of antiplatelets use and functional outcome (modified Rankin Scale at 3 months), DCI, any intracranial hemorrhagic complications including EVD tract hemorrhage and ICU length of stay (continuous variable). Results: Of the confirmed aneurysmal SAH patients (n=315), mean age was 57 years (SD 13.6) and majority of patients were female (62%) and white (70%). Thirty-nine percent of patients received antiplatelets (26% single agent; 13% dual agents) with no differences in demographics. Of the patients in the cohort, 85% received endovascular treatments (including 59% coil, 12% pipeline and stent assisted coil, 14 other endovascular treatments) and 15% underwent surgical clipping. Antiplatelets were used more in aneurysms originating from posterior circulation compared to anterior circulation (54% vs 35%, p=0.012). There was no difference in functional outcome (modified Rankin Scale at 3 months), DCI, or any intracranial hemorrhagic complications including EVD tract hemorrhage. ICU length of stay was longer in patients who received antiplatelets (3.32 additional days, 95% CI 0.4-6.3; p=0.02) and this association was independent of Hunt and Hess grades, modified Fisher scales, aneurysm treatment modality, age, comorbidities, and hospital complications. Conclusion: Use of antiplatelets may not reduce risk of DCI and worse outcome but can be associated with longer ICU length of stay. Further studies are required to identify appropriate candidates who may benefit from antiplatelets.

Impact of Stellate Ganglion Block in the Management of Cerebral Vasospasm: A Prospective Interventional Study.

Stellate ganglion block (SGB) causes blockage of sympathetic nerve activity, which may lead to intracerebral vessel dilatation and relieve cerebral vasospasm in patients of aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to evaluate the efficacy and safety of SGB to relieve cerebral vasospasm on clinicoradiological parameters. We prospectively included 20 patients with clinical and angiographic evidence of vasospasm post aneurysmal clipping. Cerebral blood flow velocity and Lindegaard ratio were assessed using transcranial Doppler (TCD). Location of vasospasm, vessel diameter, vasospasm severity, parenchymal filling time, and venous sinus filling time were assessed on digital subtraction angiography (DSA). Patients received ultrasound-guided SGB with 10 mL of 0.5% bupivacaine on the ipsilateral side of the vasospasm. After 30 minutes, the neurological status, TCD, and DSA parameters were reevaluated. After SGB, there was statistically significant reduction in the middle cerebral artery (MCA) peak systolic velocity (P = 0.005), mean flow velocity (P = 0.025), and Lindegaard ratio (P = 0.022) on TCD. We observed significant dilatation in the mean vessel diameter measured at the mid-M1 segment of MCA (P = 0.003) and mid-A1 segment of ACA (P = 0.002) on DSA. The mean parenchymal filling time and mean venous sinus filling time decreased nonsignificantly after SGB (P = 0.163/0.104). Neurological improvement was observed in five (25%) patients. SGB has positive clinicoradiological influence in the management of cerebral vasospasm of large vessels. However, its effect on cerebral microvasculature is limited and needs a larger database for further analysis.

Depression screening in aneurysmal subarachnoid haemorrhage patients and their caregivers: A systematic review

Background: Depression commonly occurs after aneurysmal subarachnoid haemorrhage (aSAH) which can negatively impact patients and their caregivers. To assist neurocritical care clinicians in determining depression in patients and their caregivers post aSAH, a validated and reliable depression screening instrument is required.

Blood Pressure Management in Critically Ill Aneurysmal Subarachnoid Haemorrhage (aSAH) Patients in Australia and New Zealand

Blood Pressure Management in Critically Ill Aneurysmal Subarachnoid Haemorrhage (aSAH) Patients in Australia and New Zealand

Role of High-Sensitivity Troponin-T And N-Terminal Pro B-Type Natriuretic Peptide as an Early Predictor of Myocardial Dysfunction in Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Study.

Acute cardiac complications are commonly seen in aneurysmal subarachnoid hemorrhage (aSAH) patients and may vary from subclinical electrocardiographic abnormalities, or reduced ejection fraction on echocardiography, elevated levels of cardiac markers (cardiac troponin and Brain natriuretic peptide) to heart failure. This study was done to evaluate the role of cardiac markers (high-sensitive Troponin-T and N-terminal pro-B-type natriuretic peptide) in early identification of cardiac complications and hence dysfunction. All consecutive patients with aSAH without any previous cardiac history were included. At admission, neurological evaluation using Hunt and Hess grading (H and H grade), with electrocardiography to look for any changes, echocardiography for ejection fraction, and any wall motion abnormalities was also done. The serial serum levels of high-sensitive Troponin-T (hsTnT) and N-terminal pro B-type natriuretic peptide (NT pro-BNP) for 7 consecutive days was measured with hsTnT >0.14 ng/ml and NT pro-BNP >150 pg/mL considered elevated. A total of 69 patients were included. The elevated peak level of hsTnT and NT pro-BNP was seen in 55.1% and 69.6% of patients. A positive correlation was seen between hsTnT (P = 0.033) and NT pro-BNP (P = 0.011) and poor SAH grade (H and H grade 3-5), similarly, abnormal ECG also significantly correlated with elevated peak hsTnT (P = 0.002) and NT proBNP (P = 0.000). Also, significant difference in peak hsTnT (P = 0.000) and NT-proBNP (P = 0.000) in patients with or without reduced ejection fraction (EF). The elevated peak levels of hsTnT and NTproBNP along with ECG and echocardiography abnormalities may help in early identification of myocardial injury, hence cardiac dysfunction.

The effects of ultra-early clipping on survival and neurological outcome in poor-grade aneurysmal subarachnoid haemorrhage

European Stroke Organisation guidelines advise treating aneurysmal subarachnoid haemorrhage (aSAH) as early as possible. However, the optimum timing along with its beneficial effects is controversial. Therefore, we aimed to investigate the effects of ultra-early clipping on neurological outcomes and survival in poor-grade aneurysmal subarachnoid haemorrhages. This retrospective study included all poor-grade aneurysmal subarachnoid haemorrhage patients treated by ultra-early surgical clipping at Trakya University Hospital between January 1, 2001, and December 31, 2020. We analysed the outcome and mortality data of these patients. Specifically, we evaluated the effects of ultra-early clipping on outcomes, defined as within six hours of the onset of symptoms. From 813 records, 212 met our inclusion criteria. Of these, 117 (55.2%) were female and 95 (44.8%) male. The mean age was 58.3 ± 13.7 years. Glasgow Outcome Scale scores differed significantly between age groups, subarachnoid haemorrhage grades, those who did and did not rebleed, and those who did or did not suffer from vasospasms. A beneficiary relationship was found between ultra-early clipping and mortality among patients. Furthermore, favourable outcomes were significantly more frequent in the ultra-early clipping group. The aSAH patients treated at our hospital who received ultra-early clipping had significantly lower mortality rates and more favourable outcomes. The difference was significant among those treated during the last decade and among patients younger than 50.

Relationship between the Micro Ribonucleic Acid-30c and Prognosis of Patients with Aneurysmal Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage is a severe neurological disease that is characterized by acute onset, multiple complications and poor prognosis. The aim of this study was to analyze the relationship between the expression level of micro ribonucleic acid-30c in plasma and prognosis in patients with aneurysmal subarachnoid hemorrhage. A total of 181 patients with aneurysmal subarachnoid hemorrhage were prospectively selected as study subjects. Modified Rankin scale was used to evaluate the prognosis of the subjects and detecting the level of micro ribonucleic acid-30c by real-time fluorescence quantitative polymerase chain reaction to analyze the relationship between micro ribonucleic acid-30c and prognosis. The levels of micro ribonucleic acid-30c in poor prognosis group (T0-micro ribonucleic acid-30c, T1-micro ribonucleic acid-30c and T2-micro ribonucleic acid-30c) were significantly lower than those in good prognosis group (p<0.05). The logistic regression analysis showed that the T2-micro ribonucleic acid-30c was an independent protective factor for the prognosis of aneurysmal subarachnoid hemorrhage patients (p<0.05). The results of restricted cubic spline fitting logistic regression analysis showed that T2-micro ribonucleic acid-30c had a non-linear relationship with the prognosis of patients with aneurysmal subarachnoid hemorrhage. The level of micro ribonucleic acid-30c in patients with aneurysmal subarachnoid hemorrhage is closely related to their prognosis. The low level of T2-micro ribonucleic acid-30c suggested a higher risk of poor prognosis.

Safety of Nimodipine in Critically Ill Aneurysmal Subarachnoid Hemorrhage Patients

Safety of Nimodipine in Critically Ill Aneurysmal Subarachnoid Hemorrhage Patients

Increased Systemic Immune-Inflammation Index Is Associated With Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage Patients.

Background: Systemic immune-inflammation index (SII) is a novel biomarker that reflects the state of a patient's inflammatory and immune status. This study aimed to determine the clinical significance of SII as a predictor of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH).Methods: Retrospective data were collected from aneurysmal SAH patients who had been admitted to our hospital between January 2015 and October 2019. Both univariate and multivariate analyses were performed to investigate whether SII was an independent predictor of DCI. In addition, the receiver operating characteristic (ROC) curve and area under the curve (AUC) were also evaluated.Results: There were 333 patients with aneurysmal SAH included in this study. Multivariate logistic analysis revealed that a modified Fisher grade 3 and 4 score [odds ratio (OR) = 7.851, 95% confidence interval (CI): 2.312–26.661, P = 0.001] and elevated SII (OR = 1.001, 95% CI: 1.001–1.002, P < 0.001) were independent risk factors for DCI. ROC curves showed that SII could predict DCI with an AUC of 0.860 (95% CI: 0.818–0.896, P < 0.001). The optimal cut-off value for SII to predict DCI was 1,424, and an SII ≥ 1,424 could predict DCI with a sensitivity of 93.1% and a specificity of 68.1%. Patients with higher SII value on admission tended to have higher incidence of acute hydrocephalus and DCI, greater modified Fisher and Hunt-Hess scales, and poorer outcomes.Conclusions: SII is an independent predictor of DCI in patients with aneurysmal SAH. The SII system can be implemented in a routine clinical setting to help clinicians diagnose patients with high risk of DCI.

Increase in Brain Volume After Aneurysmal Subarachnoid Hemorrhage Leads to Unfavorable Outcome: A Retrospective Study Quantified by CT Scan.

Background and Purpose: Primary brain swelling occurs in aneurysmal subarachnoid hemorrhage (aSAH) patients. The absence of a dynamic quantitative method restricts further study of primary brain swelling. This study compared differences in the change rate of brain volume (CRBV) between patients with and without primary brain swelling in the early stage of aSAH. Moreover, the relationship between CRBV and clinical outcomes was evaluated.Methods: Patients hospitalized within 24 h after aSAH were included in this retrospective study. Utilizing a qualitative standard established before the study to recognize primary brain swelling through brain CT after aSAH, clinical outcomes after 3 months of SAH were evaluated with a modified Rankin scale (mRS). The brain volume (BV) of each patient was calculated with a semiautomatic threshold algorithm of 3D-slicer, and the change in brain volume (CIBV) was obtained by subtracting the two extreme values (CIBV = BVmax – BVmin). The CRBV was obtained by CIBV/BVmin × 100%. The CRBV values that predicted unfavorable prognoses were estimated.Results: In total, 130 subjects were enrolled in the study. The mean CRBV in the non-swelling group and swelling group were 4.37% (±4.77) and 11.87% (±6.84), respectively (p < 0.05). CRBV was positively correlated with the length of hospital stay, blood in the ambient cistern, blood in the lateral ventricle, and lateral ventricular volume (Spearman ρ = 0.334; p < 0.001; Pearson ρ = 0.269, p = 0.002; Pearson ρ = 0.278, p = 0.001; Pearson ρ = 0.233, p = 0.008, respectively). Analysis of variance showed significant differences in CIBV, CRBV, blood in the ambient cistern, blood in the lateral ventricle, and lateral ventricular volume among varying modified Fisher scale (mFisher), with higher admission mFisher scale, indicating larger values of these variables. After adjusting for risk factors, the model showed that for every 1% increase in the CRBV, the probability of poor clinical prognosis increased by a factor of 1.236 (95% CI = 1.056–1.446). In the stratified analysis, the odds of worse clinical outcomes increased with increases in the CRBV. Receiver operating characteristic curve analysis showed that HH grade, mFisher scale, and score of CRBV (SCRBV) had diagnostic performance for predicting unfavorable clinical outcomes.Conclusion: Primary brain swelling increases brain volume after aSAH. The CRBV quantified by 3D-Slicer can be used as a volumetric representation of the degree of brain swelling. A larger CRBV in the early stage of aSAH is associated with poor prognosis. The CRBV can be used as a neuroimaging biomarker of early brain injury after bleeding and may be an effective predictor of patients' clinical prognoses.

An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial.

The SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management. The records of all patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) were retrospectively reviewed, and the patients were assigned SAFIRE grades. Outcomes at 1 year and 6 years post-aSAH were analyzed for each SAFIRE grade level, with a poor outcome defined as a modified Rankin Scale score > 2. Univariate analysis was performed for patients with a high SAFIRE grade (IV or V) for odds of poor outcome at the 1- and 6-year follow-ups. A total of 405 patients with confirmed aSAH enrolled in the BRAT were analyzed; 357 patients had 1-year follow-up, and 333 patients had 6-year follow-up data available. Generally, as the SAFIRE grade increased, so did the proportion of patients with poor outcomes. At the 1-year follow-up, 18% (17/93) of grade I patients, 22% (20/92) of grade II patients, 32% (26/80) of grade III patients, 43% (38/88) of grade IV patients, and 75% (3/4) of grade V patients were found to have poor outcomes. At the 6-year follow-up, 29% (23/79) of grade I patients, 24% (21/89) of grade II patients, 38% (29/77) of grade III patients, 60% (50/84) of grade IV patients, and 100% (4/4) of grade V patients were found to have poor outcomes. Univariate analysis showed that a SAFIRE grade of IV or V was associated with a significantly increased risk of a poor outcome at both the 1-year (OR 2.5, 95% CI 1.5-4.2; p < 0.001) and 6-year (OR 3.7, 95% CI 2.2-6.2; p < 0.001) follow-ups. High SAFIRE grades are associated with an increased risk of a poor recovery at late follow-up.