Prognosis Of Aneurysmal Subarachnoid Hemorrhage Research Articles

Predicting who has delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage using machine learning approach: a multicenter, retrospective cohort study.

Early prediction of delayed cerebral ischemia (DCI) is critical to improving the prognosis of aneurysmal subarachnoid hemorrhage (aSAH). Machine learning (ML) algorithms can learn from intricate information unbiasedly and facilitate the early identification of clinical outcomes. This study aimed to construct and compare the ability of different ML models to predict DCI after aSAH. Then, we identified and analyzed the essential risk of DCI occurrence by preoperative clinical scores and postoperative laboratory test results. This was a multicenter, retrospective cohort study. A total of 1039 post-operation patients with aSAH were finally included from three hospitals in China. The training group contained 919 patients, and the test group comprised 120 patients. We used five popular machine-learning algorithms to construct the models. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and f1 score were used to evaluate and compare the five models. Finally, we performed a Shapley Additive exPlanations analysis for the model with the best performance and significance analysis for each feature. A total of 239 patients with aSAH (23.003%) developed DCI after the operation. Our results showed that in the test cohort, Random Forest (RF) had an AUC of 0.79, which was better than other models. The five most important features for predicting DCI in the RF model were the admitted modified Rankin Scale, D-Dimer, intracranial parenchymal hematoma, neutrophil/lymphocyte ratio, and Fisher score. Interestingly, clamping or embolization for the aneurysm treatment was the fourth button-down risk factor in the ML model. In this multicenter study, we compared five ML methods, among which RF performed the best in DCI prediction. In addition, the essential risks were identified to help clinicians monitor the patients at high risk for DCI more precisely and facilitate timely intervention.

Baseline and average platelet count can predict the outcome of patients with aneurysmal subarachnoid hemorrhage

BackgroundBaseline values and the change of platelet count (PLT) during disease were reported to be associated with prognosis of patients with cancer and intensive care treatment. We aimed to evaluate the association between PLT with the course and prognosis of aneurysmal subarachnoid hemorrhage (SAH). MethodsAdmission (AdmPLT) and the 14-days mean PLT (MeanPLT) values of 763 SAH patients treated between 01/2005 and 06/2016 were recorded and, for further analysis, divided into four categories: <150, 150–260, 261–400 and > 400 × 109/L. Primary endpoints were cerebral infarcts in follow-up computed tomography scans, in-hospital mortality and unfavorable outcome at 6-months follow-up defined as modified Rankin scale>3. Adverse events during SAH were assessed as secondary endpoints. ResultsHigher PLT values were independently associated with lower risk of cerebral infarction (MeanPLT: aOR = 0.65 per-PLT-category-increase, p = 0.001), in-hospital mortality (AdmPLT: aOR = 0.64, p = 0.017; MeanPLT: aOR = 0.23, p < 0.0001) and unfavorable outcome (AdmPLT: aOR = 0.70, p = 0.031; MeanPLT: aOR = 0.35, p < 0.0001). Moreover, individuals with poorer outcome were less prone to PLT increase during SAH (mean values: -+20.3 vs + 30.5 × 109/L for cerebral infarction; +9.3 vs + 32.8 × 109/L for in-hospital mortality; +14.4 vs + 31.1 × 109/L for unfavorable outcome). The following adverse events during SAH were related to AdmPLT and/or MeanPLT: non-aneurysm related secondary rebleeding, intracranial hypertension requiring conservative treatment or decompressive craniectomy, sepsis and acute kidney failure. ConclusionLow PLT at admission and their less prominent increase during SAH were strongly linked with poor outcome of SAH. Further analysis is required to clarify the background of this association and potential therapeutic implications.

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

No evidence has established a direct causal relationship between early microcirculation disturbance after aneurysmal subarachnoid hemorrhage (aSAH) and neurological function prognosis, which is the key pathophysiological mechanism of early brain injury (EBI) in patients with aSAH. A total of 252 patients with aSAH were enrolled in the Neurosurgical Intensive Care Unit of Southwest Hospital between January 2020 and December 2022 and divided into the no neurological deterioration, early neurological deterioration, and delayed neurological deterioration groups. Indicators of microcirculation disorders in EBI included regional cerebral oxygen saturation (rSO2) measured by near-infrared spectroscopy (NIRS), brain oxygen monitoring, and other clinical parameters for evaluating neurological function and determining the prognosis of patients with aSAH. Our data suggest that the rSO2 is generally lower in patients who develop neurological deterioration than in those who do not and that there is at least one time point in the population of patients who develop neurological deterioration where left and right cerebral hemisphere differences can be significantly monitored by NIRS. An unordered multiple-classification logistic regression model was constructed, and the results revealed that multiple factors were effective predictors of early neurological deterioration: reoperation, history of brain surgery, World Federation of Neurosurgical Societies (WFNS) grade4-5, Fisher grade3-4, SAFIRE grade 3-5, abnormal serum sodium and potassium levels, and reduced rSO2 during the perioperative period. However, for delayed neurological deterioration in patients with aSAH, only a history of brain surgery and perioperative RBC count were predictive indicators. The rSO2 concentration in patients with neurological deterioration is generally lower than that in patients without neurological deterioration, and at least one time point in the population with neurological deterioration can be significantly monitored via NIRS. However, further studies are needed to determine the role of microcirculation and other predictive factors in the neurocritical management of EBI after aSAH, as these factors can reduce the incidence of adverse outcomes and mortality during hospitalization.

Associations of neutrophil to lymphocyte ratio and red cell distribution width on different days with the prognosis of aneurysmal subarachnoid hemorrhage patients.

The associations of neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) with the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) patients were confirmed in a few studies. But NLR and RDW levels in most of these studies were on admission. Here we carried 1 retrospective study including 150 patients with aSAH who underwent surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to February 2023 to explore the associations on the preoperative day, the first (1st), third (3rd), and seventh (7th) postoperative days. The level of RDW on the 3rd postoperative day and level of NLR on the 7th postoperative day in patients with poor prognosis were significantly higher than patients with good prognosis. The results of multivariate logistic analysis also confirmed the associations of RDW on the 3rd postoperative day (OR = 16.785, 95% CI: 4.077-69.107, P < .001) and NLR on the 7th postoperative day (OR = 8.399, 95% CI: 2.167-32.544, P = .002) with prognosis of aSAH patients. The results of receiver operating characteristic curve showed that cutoff values of RDW and NLR for predicting the prognosis in aSAH patients were 13.05% and 6.97, respectively. Higher RDW on the 3rd postoperative day and NLR on the 7th postoperative day were possibly associated with poor prognosis of aSAH patients. We should pay attention to the RDW and NLR levels during different hospitalization periods, especially in the short postoperative period. Moreover, the cutoff values for predicting prognosis need to be validated in larger-sample studies.

Association between neutrophil-to-albumin ratio and long-term mortality of aneurysmal subarachnoid hemorrhage

ObjectiveThe prognosis of aneurysmal subarachnoid hemorrhage (aSAH) survivors is concerning. The goal of this study was to investigate and demonstrate the relationship between the neutrophil-to-albumin ratio (NAR) and long-term mortality of aSAH survivors.MethodsA retrospective observational cohort study was conducted at Sichuan University West China Hospital between January 2009 and June 2019. The investigation of relationship between NAR and long-term mortality was conducted using univariable and multivariable Cox regression models. To demonstrate the predictive performance of different biomarkers over time, time-dependent receiver operating characteristic curve (ROC) analysis and decision curve analysis (DCA) were created.ResultsIn total, 3173 aSAH patients were included in this study. There was a strong and continuous relationship between NAR levels and long-term mortality (HR 3.23 95% CI 2.75–3.79, p < 0.001). After adjustment, the result was still significant (adjusted HR 1.78 95% CI 1.49–2.12). Compared with patients with the lowest quartile (< 0.15) of NAR levels, the risk of long-term mortality in the other groups was higher (0.15–0.20: adjusted HR 1.30 95% CI 0.97–1.73; 0.20–0.28: adjusted HR 1.37 95% CI 1.03–1.82; >0.28: adjusted HR 1.74 95% CI 1.30–2.32). Results in survivors were found to be still robust. Moreover, out of all the inflammatory markers studied, NAR demonstrated the highest correlation with long-term mortality.ConclusionsA high level of NAR was associated with increased long-term mortality among patients with aSAH. NAR was a promising inflammatory marker for long-term mortality of aSAH.

Serum Sestrin2 Emerges as a Prognostic Biomarker of Human Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Cohort Single-Center Study.

Sestrin2 functions as a neuroprotective factor. Herein, serum sestrin2 was investigated with respect to its associations with severity, delayed cerebral ischemia (DCI) and prognosis of aneurysmal subarachnoid hemorrhage (aSAH). In this prospective, observational, cohort, single-center study, serum sestrin2 levels were measured at entry into the study in 45 healthy controls and at admission in 135 aSAH patients. Also, they were gauged in other time points (namely, at days 1, 2, 3, 5 and 7) among 45 patients. Unfavorable prognosis was defined as extended Glasgow Outcome Scale (GOSE) scores of 1-4 at six months after aSAH. Serum sestrin2 levels were immediately raised at admission in patients, increased thereafter, peaked at day 2, declined afterwards till day 7, and were significantly higher than those in controls (all P<0.001). Serum sestrin2 levels had independent correlation with Hunt-Hess scores (beta, 1.715; 95% confidence interval (CI), 0.595-2.835; P=0.003) and modified Fisher scores (beta, 2.505; 95% CI, 1.102-3.907; P=0.001). Alternatively, serum sestrin2 levels, which were independently correlated with 6-month GOSE scores (beta, -0.050; 95% CI, -0.099-0.001; P=0.044), were independently associated with DCI (odds ratio, 1.079; 95% CI, 1.008-1.156; P=0.029) and unfavorable prognosis (odds ratio, 1.093; 95% CI, 1.020-1.172; P=0.012). DCI and prognosis prediction models, which were composed of serum sestrin2, Hunt-Hess scores and modified Fisher scores, were comparatively stable and clinically beneficial under calibration curve and decision curve. Prognosis prediction model showed significantly higher area under receiver operating characteristic curve than serum sestrin2, Hunt-Hess scores and modified Fisher scores alone (all P<0.05). A significant enhancement of serum sestrin2 levels after aSAH is independently related to severity, DCI and poor prognosis following aSAH. The models incorporating serum sestrin2 perform well in predicting the DCI and prognosis of aSAH patients. Presumably, determination of serum sestrin2 may be of clinical significance in aSAH.

Association of serum glucose/potassium ratio with the prognosis of aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis (S36.004)

<h3>Objective:</h3> To conduct a systematic review with meta-analysis to evaluate the current evidence on the prognostic value of GPR in patients with aSAH. <h3>Background:</h3> Currently, the glucose/potassium ratio (GPR) is an important biomarker indicating the abundant release of catecholamines during aneurysmal subarachnoid hemorrhage (aSAH), which triggers different alterations in patients. <h3>Design/Methods:</h3> A systematic search was conducted in PubMed, Embase, Scopus, Web of Science, Google Scholar, Lilacs, and Cochrane Library until April 2022. The quality of the included studies was assessed using the New Castle-Ottawa tool. A meta-analysis with randomized effects model was applied using the Paule-Mendel estimator to estimate the pooled effect of the outcome and a narrative synthesis when this was not possible. GRADE criteria for continuous outcomes and narrative review were used to assess the certainty of the evidence. <h3>Results:</h3> Four of 368 studies were selected. With high certainty, we reported that a significant increase in GPR values was found in patients with a poor outcome according to Glasgow Scale Score (MD: 14.81; 95 CI: 12.47;17.15; I2=0%). With moderate certainty, we found a specificity of 0.50 for mortality at 3 months and with high certainty, a sensitivity of 0.90 for the mortality at 3 months. With a moderate certainty, one study showed a mean difference of 5.3 between poor and good prognosis (Rankin Scale &gt; 2 at 3 months) and with the same certainty, we found a specificity of 0.63 for poor prognosis at 1 year (Rankin Scale &gt; 2). <h3>Conclusions:</h3> With moderate certainty of the evidence, we found that GPR is useful as a prognostic biomarker in patients with aSAH. However, more research is required to control possible confounding variables through sensitivity and specificity analysis. <b>Disclosure:</b> Miss Cruzalegui Bazán has nothing to disclose. Miss Cierto Torre has nothing to disclose. Mr. Vallejos has nothing to disclose. Miss Ticona Flores has nothing to disclose. Dr. Acha Sanchez has nothing to disclose. Mr. Cabanillas Lazo has nothing to disclose.

Improving the models for prognosis of aneurysmal subarachnoid hemorrhage with the neutrophil-to-albumin ratio.

Many peripheral inflammatory markers were reported to be associated with the prognosis of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to identify the most promising inflammatory factor that can improve existing predictive models. The study was based on data from a 10 year retrospective cohort study at Sichuan University West China Hospital. We selected the well-known SAFIRE and Subarachnoid Hemorrhage International Trialists' (SAHIT) models as the basic models. We compared the performance of the models after including the inflammatory markers and that of the original models. The developed models were internally and temporally validated. A total of 3,173 patients were included in this study, divided into the derivation cohort (n = 2,525) and the validation cohort (n = 648). Most inflammatory markers could improve the SAH model for mortality prediction in patients with aSAH, and the neutrophil-to-albumin ratio (NAR) performed best among all the included inflammatory markers. By incorporating NAR, the modified SAFIRE and SAHIT models improved the area under the receiver operator characteristics curve (SAFIRE+NAR vs. SAFIRE: 0.794 vs. 0.778, p = 0.012; SAHIT+NAR vs. SAHIT: 0.831 vs. 0.819, p = 0.016) and categorical net reclassification improvement (SAFIRE+NAR: 0.0727, p = 0.002; SAHIT+NAR: 0.0810, p < 0.001). This study illustrated that among the inflammatory markers associated with aSAH prognosis, NAR could improve the SAFIRE and SAHIT models for 3 month mortality of aSAH.

Predictive performance for prognosis of aneurysmal subarachnoid hemorrhage with ventricular hemorrhage by imaging combined with clinical and laboratory quantitative index model

Objective: To explore the predictive performance of image quantitative index model, clinical-laboratory index model and image-clinical multi-dimensional fusion model in predicting the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) with intraventricular hemorrhage (IVH). Methods: A total of 349 patients with aSAH and IVH, including 122 males and 227 females, aged 22 to 85 (59±11) years underwent CT scan in the General Hospital of Eastern Theater Command from January 2010 to December 2019 were used as dataset 1 to construct a prognostic model. A prognostic model was constructed for data set 1, and the functional recovery of patients 12 months after discharge was evaluated using the modified Rankin Scale (mRS). According to the results, those patients were divided into two groups: good outcome group (n=267) and poor outcome group (n=82). In addition, 63 aSAH patients with IVH, including 27 males and 36 females, aged 32 to 87 (61±12) years who were admitted to the General Hospital of Eastern Theater Command from January 2020 to December 2021 were collected as dataset 2 for independent verification of the model, including 30 patients with poor prognosis. Clinical information (age and gender), laboratory indicators (blood routine and blood biochemistry), and imaging quantitative indicators (such as volume, density, shape of each ventricle hemorrhage area outlined and extracted on head CT scan etc.) were recorded for all patients (dataset 1 and 2). The clinical, laboratory and imaging quantitative indicators of dataset 1 were screened by using L1 regularization and multiple logistic regression method was used to construct the clinical-laboratory index model, image quantitative index model and image-clinical multi-dimensional fusion model, according to the weight coefficient of features in the clinical-laboratory index model and image quantitative index model, screen out the main features. The model was trained and internally validated by 5-fold cross-validation. The model was validated independently in dataset 2. Results: The AUC (area under the ROC curve) of clinical-laboratory index model, image quantitative index model and multidimensional fusion model constructed based on dataset 1 were 0.75 (95%CI: 0.69-0.81), 0.68 (95%CI: 0.61-0.74) and 0.86 (95%CI: 0.82-0.91). The Delong test showed that there were statistically significant differences between the performance of the multi-dimensional fusion model and the clinical-laboratory index model or image quantitative index model (all P<0.05). The AUC of clinical-laboratory index model, image quantitative index model and multidimensional fusion model of dataset 2 were 0.79 (95%CI: 0.68-0.91), 0.70 (95%CI: 0.57-0.83) and 0.81 (95%CI: 0.70-0.92). In addition, in the clinical-laboratory index model and imaging quantitative index model constructed based on data 1, age, Hunt-Hess grade on admission, Neutrophil/Lymphocyte (N/L) (the weight coefficients in the clinical-laboratory index model were 1.00, -0.59 and 0.44) and the standard deviation of third ventricle hemorrhage density, minimum hemorrhage density of the fourth ventricle, and left ventricle hemorrhage sphericity (the weight coefficients in the image quantitative index model were -1.00, 0.85 and -0.84) were the main features of the screening. Conclusions: Quantitative imaging indicators of ventricular hemorrhage (standard deviation of third ventricular hemorrhage density, minimum density of fourth ventricular hemorrhage, and left ventricular sphericity) are helpful to predict the poor prognosis of patients with aSAH with ventricular hemorrhage. Dimensional fusion model has greater value in predicting poor prognosis of patients.

Predictors of Outcome of Aneurysmal Subarachnoid hemorrhage

Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH) is a devastating condition with high mortality and morbidity. Significant factors influencing the prognosis of aneurysmal subarachnoid hemorrhage (SAH) include the severity at presentation of the disease and delayed cerebral ischemia (DCI).&#x0D; Methods: This is a prospective study conducted in Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Bansbari, Kathmandu, Nepal among patients who underwent clipping of aneurysm for subarachnoid hemorrhage. Various clinical and radiological prognostic factors were registered on admission and during the intensive care stay. Outcome was recorded. GOS&gt;3 was considered good outcome and GOS ≤3 was considered poor outcome.&#x0D; Results: Seventy-two patients with ruptured aneurysm were surgically clipped. Good outcome was observed in 51 (70.83%) patients while poor outcome was seen among 21 (29.17%) patients including death among 16 (22.2%) patients. In univariate analysis, WFNS&gt;2, Fisher grade &gt;2, EVD placement for hydrocephalus and delayed cerebral ischemia (DCI) were found to have statistically significant in poor outcome. On Multivariate logistic regression model showed delayed cerebral ischemia was statistically significant predictor of poor outcome at p= 0.032 (OR= 7.34; 95% CI=1.280 to 17.702).&#x0D; Conclusion: WFNS &gt;2, Fisher grade&gt;2, EVD placement and DCI were found to have statistical significance in poor outcome while only DCI was an independent predictor of poor outcome following aneurysmal Subarachnoid Hemorrhage (aSAH).

Clinical relevance of serum procalcitonin in patients with aneurysmal subarachnoid hemorrhage.

Cerebral vasospasm (CV), which is closely related to the prognosis of aneurysmal subarachnoid hemorrhage (aSAH), is known to be related to an inflammatory reaction. The aim of the present study was to investigate predictable values of procalcitonin (PCT) for systemic infection and the development of CV in patients with aSAH. Patients who underwent endovascular treatment for aSAH were retrospectively enrolled. Receiver operating characteristic curve analysis was performed to evaluate the predicable value of PCT for systemic infection and CV in patients with aSAH. To clarify the association of PCT and CV, additional subgroup analysis was performed for patients without systemic infection. Multivariate logistic regression was used to explore the associations of PCT and the development of CV. A total of 374 patients with aSAH were enrolled. Of them, 164 (43.9%) had systemic infection. Optimal cutoff value of PCT for systemic infection was 0.21 ng/ml (P<0.001). In subgroup analysis of 210 patients without infection, 0.09 ng/ml of PCT level was defined as the optimal cutoff value for predicting CV after aSAH (P<0.001). In multivariate logistic regression analysis, PCT was a significant predicting factor for CV (odds ratio, 1.82; 95% confidence interval, 1.42-2.96; P=0.015). Overall, PCT had predictable value for systemic infection and the development of CV in patients who underwent endovascular treatment for aSAH. Further studies are needed to validate our results and establish its clinical applicability.

Association of cerebrospinal fluid advanced oxidation protein products levels with early brain injury and prognosis of aneurysmal subarachnoid hemorrhage: A preliminary prospective study

ObjectivesIn this study, we investigated the time course in the cerebrospinal fluid (CSF) advanced oxidation protein products (AOPPs) levels in patients with aneurysmal subarachnoid hemorrhage (aSAH), and ascertained the relationship between the levels of AOPPs and early brain injury (EBI), hydrocephalus and prognosis of patients with aSAH. MethodsWe measured the CSF AOPPs levels in 50 patients with aSAH at 1–3 d, 4–6 d, 7–9 d, and 10–12 d after hemorrhage. The modified Fisher grades, Hunt-Hess grades, CSF IL-6 levels, peripheral blood count of white blood cells, cerebral edema scores and hydrocephalus were used to assess the severity of brain injury. Modified Rankin Scale (mRS) scores were used to assess the prognosis. Patients with mRS scores greater than 2 were considered to have a poor outcome. ResultsCSF AOPPs levels were significantly higher in patients with aSAH with poor prognosis, compared to patients with good prognosis and peaked in the early stage. Among patients with aSAH, the levels of CSF AOPPs on days 1–3 were significantly correlated with modified Fisher grades, Hunt-Hess grades, CSF IL-6 levels, peripheral blood count of white blood cells, and cerebral edema scores. Also, in patients with hydrocephalus, early CSF AOPPs levels were significantly elevated. Levels of CSF AOPPs in aSAH patients on days 1–3, 4–6, and 7–9 were independently associated with poor prognosis at the 90-day follow-up, and the optimal area under the curve (AUC) values for CSF AOPPs levels were found on days 1–3. ConclusionsAOPPs may serve as the potential biomarker to assess the severity of EBI and prognosis in patients with aSAH.

Skeletal muscle atrophy and myosteatosis are not related to long-term aneurysmal subarachnoid hemorrhage outcome.

The prognosis of aneurysmal subarachnoid hemorrhage (aSAH) is highly variable. This study aims to investigate whether skeletal muscle atrophy and myosteatosis are associated with poor outcome after aSAH. In this study, a cohort of 293 consecutive aSAH-patients admitted during a 4-year period was retrospectively analyzed. Cross-sectional muscle measurements were obtained at the level of the third cervical vertebra. Muscle atrophy was defined by a sex-specific cutoff value. Myosteatosis was defined by a BMI-specific cutoff value. Poor neurological outcome was defined as modified Rankin Scale 4-6 at 2 and 6-month follow-up. Patient survival state was checked until January 2021. Generalized estimating equation was performed to assess the effect of muscle atrophy / myosteatosis on poor neurological outcome after aSAH. Cox regression was performed to analyze the impact of muscle atrophy and myosteatosis on overall survival. The study found that myosteatosis was associated with poor neurological condition (WFNS 4-5) at admission after adjusting for covariates (odds ratio [OR] 2.01; 95%CI 1.05,3.83; P = .03). It was not associated with overall survival (P = .89) or with poor neurological outcomes (P = .18) when adjusted for other prognostic markers. Muscle atrophy was not associated with overall survival (P = .58) or neurological outcome (P = .32) after aSAH. In conclusion, myosteatosis was found to be associated with poor physical condition directly after onset of aSAH. Skeletal muscle atrophy and myosteatosis were however irrelevant to outcome in the Western-European aSAH patient. Future studies are needed to validate these finding.

Plasma cellular prion protein concentrations correlate with severity and prognosis of aneurysmal subarachnoid hemorrhage

BackgroundCellular prion protein (PrPc) is greatly expressed in injured brain tissues. We investigates correlation of plasma PrPc concentrations with severity, delayed cerebral ischemia (DCI) plus prognosis following aneurysmal subarachnoid hemorrhage (aSAH). MethodsPlasma PrPc concentrations were measured in 110 aSAH patients and 110 healthy controls. The World Federation of Neurological Surgeons scale (WFNS) score, Glasgow coma scale (GCS) score, Hunt-Hess score and modified Fisher score were utilized to assess hemorrhagic severity. Relations of plasma PrPc concentrations to DCI and 90-day poor outcome (Glasgow outcome scale score of 1–3) were analyzed using multivariate analysis. Prognostic predictive capabilities were determined under receiver operating characteristic curve. ResultsPlasma PrPc concentrations were significantly higher in patients than in controls. Plasma PrPc concentrations were tightly correlated with WFNS score, GCS score, Hunt-Hess score and modified Fisher score. Plasma PrPc emerged as an independent predictor for 90-day poor outcome, but not for DCI. Plasma PrPc concentrations exhibited similar prognostic predictive abilities, as compared to WFNS score, GCS score, Hunt-Hess score and modified Fisher score. ConclusionsPlasma PrPc concentrations are highly associated with severity and poor outcome after hemorrhagic stroke, indicating that plasma PrPc may serve as a useful prognostic biomarker for aSAH.

Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study.

BackgroundThe prevalence of risk factors for poor outcomes from aneurysmal subarachnoid hemorrhage (SAH) varies widely and has not been fully elucidated to date in Vietnam. Understanding the risk and prognosis of aneurysmal SAH is important to reduce poor outcomes in Vietnam. The aim of this study, therefore, was to investigate the rate of poor outcome at 90 days of ictus and associated factors from aneurysmal SAH in the country.MethodsWe performed a multicenter prospective cohort study of patients (≥18 years) presenting with aneurysmal SAH to three central hospitals in Hanoi, Vietnam, from August 2019 to August 2020. We collected data on the characteristics, management, and outcomes of patients with aneurysmal SAH and compared these data between good (defined as modified Rankin Scale (mRS) of 0 to 3) and poor (mRS, 4–6) outcomes at 90 days of ictus. We assessed factors associated with poor outcomes using logistic regression analysis.ResultsOf 168 patients with aneurysmal SAH, 77/168 (45.8%) were men, and the median age was 57 years (IQR: 48–67). Up to 57/168 (33.9%) of these patients had poor outcomes at 90 days of ictus. Most patients underwent sudden-onset and severe headache (87.5%; 147/168) and were transferred from local to participating central hospitals (80.4%, 135/168), over half (57.1%, 92/161) of whom arrived in central hospitals after 24 hours of ictus, and the initial median World Federation of Neurological Surgeons (WFNS) grading score was 2 (IQR: 1–4). Nearly half of the patients (47.0%; 79/168) were treated with endovascular coiling, 37.5% (63/168) were treated with surgical clipping, the remaining patients (15.5%; 26/168) did not receive aneurysm repair, and late rebleeding and delayed cerebral ischemia (DCI) occurred in 6.1% (10/164) and 10.4% (17/163) of patients, respectively. An initial WFNS grade of IV (odds ratio, OR: 15.285; 95% confidence interval, CI: 3.096–75.466) and a grade of V (OR: 162.965; 95% CI: 9.975–2662.318) were independently associated with poor outcomes. Additionally, both endovascular coiling (OR: 0.033; 95% CI: 0.005–0.235) and surgical clipping (OR: 0.046; 95% CI: 0.006–0.370) were inversely and independently associated with poor outcome. Late rebleeding (OR: 97.624; 95% CI: 5.653–1686.010) and DCI (OR: 15.209; 95% CI: 2.321–99.673) were also independently associated with poor outcome.ConclusionsImprovements are needed in the management of aneurysmal SAH in Vietnam, such as increasing the number of aneurysm repairs, performing earlier aneurysm treatment by surgical clipping or endovascular coiling, and improving both aneurysm repairs and neurocritical care.

Association between HbA1C (Glycated Hemoglobin) and Clinical Outcomes in Patients with Subarachnoid Hemorrhage After Neuro-intervention

Our study investigated the association between the level of HbA1c (glycated hemoglobin) at admission and the prognosis of aneurysmal subarachnoid hemorrhage (SAH). A total of 510 patients treated with neuro-intervention for aneurysmal SAH and with data for admission HbA1c (glycated hemoglobin) were included. Favorable clinical outcome was defined as modified Rankin Scale (mRS) score of 0-2 at 3 months. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff value of HbA1C for unfavorable clinical outcomes. Logistic regression was used to evaluate the association between HbA1C level and outcomes. The optimal cutoff value of HbA1C was identified as 6.0% (P < 0.001), and patients with a high HbA1C (≥ 6.0%) had a lower prevalence of favorable clinical outcomes than patients with low HbA1C (< 6.0%) (P < 0.001). High HbA1C (≥ 6.0%) was independently associated with unfavorable clinical outcome (OR 2.84; 95% CI: 1.52-5.44; P = 0.004). The risk of unfavorable clinical outcome was significantly increased in patients with HbA1C (≥ 7.0%, < 8%) and HbA1C (≥ 8.0%) compared with lower baseline HbA1C (≥ 6.0%, < 7%) values (OR 2.17; 95% CI: 1.87-5.13; P = 0.011 and OR 4.25; 95% CI: 3.17-8.41; P = 0.005). Our study showed that HbA1C could be an independent predictor of worse outcomes following neuro-intervention for aneurysmal SAH. High HbA1C (≥ 6.0%) was associated with unfavorable clinical outcomes, and gradual elevation of HbA1C contributed to an increase in the risk of worse clinical outcomes after SAH.

Terson sign:

Terson's sign (TS) is classically defined as vitreous hemorrhage associated with subarachnoid hemorrhage of aneurysmal origin, being an important predictor of severity, indicating greater morbidity and mortality when compared to patients without the sign. The objective of this study is to review the relationship of Terson syndrome/Terson sign with the prognosis of aneurysmal subarachnoid hemorrhage. A search for original articles, research and case reports was performed on the PubMed, Scielo, Cochrane and ScienceDirect platform, with the following descriptors: Terson sign and subarachnoid hemorrhage. Retrospective, prospective articles and case reports published in the last 5 years and which were in accordance with the established objective and inclusion criteria were selected. Ten (10) articles were selected, in which the available results show an unfavorable prognostic relationship of TS and subarachnoid hemorrhage, because these patients had a worse clinical status assessed on the Glasgow scales ≤ 8, Hunt &amp; Hess &gt; III, Fisher &gt; 3, in addition to intracranial hypertension and location of the aneurysm in the anterior communicating artery complex. The early recognition of this condition described by Albert Terson in 1900 brought an important contribution to neurosurgery, being recognized until nowadays.

Prognostic value of admission serum glucose-phosphate ratio in predicting the 6-month outcome of patients with severe traumatic brain injury: A retrospective study

BackgroundSerum glucose-phosphate ratio has been revealed to be associated with severity and prognosis of aneurysmal subarachnoid hemorrhage. Objective of this study was to investigate the relationship between serum glucose-phosphate ratio and severe traumatic brain injury outcome. MethodsPatients with severe traumatic brain injury were stratified in quartiles according to their serum glucose-phosphate ratio. Outcome parameters included mortality, overall survival and poor outcome defined as Glasgow outcome scale score of 1–3 at post-traumatic 6 months. Multiple logistic regression analysis was performed to evaluate the association between quartiles of serum glucose-phosphate ratio and outcome. ResultsData from 105 patients were retrospectively reviewed. Glasgow coma scale score declined, Glasgow outcome scale score decreased, Rotterdam computed tomography classification were raised, mortality increased, overall survival probability reduced and percentage of poor outcome rose significantly with each quartile of serum glucose-phosphate ratio. After adjusting for other confounding factors, serum glucose-phosphate ratio according to quartiles was substantially related to 6-month mortality, overall survival and poor outcome. Under receiver operating characteristic curve, serum glucose-phosphate ratio showed a significantly high prognostic predictive capability. ConclusionsSerum glucose-phosphate ratio might be a potential variable that can reflect trauma severity and prognosis in patients with severe traumatic brain injury.

Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage.

BackgroundThis study was to conduct a predictive model for the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) and validate the clinical data.MethodsA total of 235 aSAH patients were enrolled in this study, dividing into the favorable or poor prognosis groups based on Modified Rankin Scale (mRS) at 3 months postoperatively. Multivariate analysis was assessed using binary Logistic regression and Fisher discriminant analysis. The receiver operating characteristic (ROC) curve was used to determine the cut‐off value.ResultsOur findings showed that the high Glasgow Coma Scale (GCS) score 24‐hour after surgery reduced the risk of poor prognosis, and the surgical clipping and elevated neutrophil‐lymphocyte ratio (NLR) increased the risk of poor prognosis. The discriminant function was V = 0.881 × GCS score − 0.523 × NLR − 0.422 × therapeutic approach, and V = −0.689 served as a cut‐off value. When V ≥ −0.689, the good prognosis was considered among these patients with aSAH. The correctness for predicting the prognostic outcomes by self‐validation was 85.11%.ConclusionThis predictive model established by a discriminant analysis is a useful tool for predicting the prognostic outcomes of aSAH patients, which may help clinicians identify patients at high risk for poor prognosis and optimize treatment after surgery.

Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 concentrations and prognosis of aneurysmal subarachnoid hemorrhage

BackgroundOxidized low-density lipoprotein (ox-LDL) and its receptor, lectin-like ox-LDL receptor-1 (LOX-1) are involved in the pathogenesis of atherosclerosis. Expression of LOX-1 was substantially raised in the basilar arterial wall of subarachnoid hemorrhage (SAH) rabbits. We ascertained the relationship between serum soluble LOX-1 concentrations and functional outcome after human aneurysmal SAH. MethodsWe enrolled 94 aneurysmal SAH patients and 94 healthy controls. Serum soluble TOX-1 concentrations were quantified using commercial enzyme-linked immunosorbent assay kit. A poor outcome was defined as Glasgow outcome scale score of 1–3. ResultsMedian values of serum soluble LOX-1 in stroke patients were significantly higher than those in controls (1.5 vs. 0.4 ng/ml, P < 0.001). Thirty patients (31.9%) had a poor outcome at 6 months after stroke. Serum soluble LOX-1 was a strong predictor of poor outcome (OR 5.20, 95% CI 1.25–22.04). Serum soluble LOX-1 concentrations exhibited a significant discriminatory capability (area under curve 0.811, 95% confidence interval 0.717–0.884). The predictive powers of World Federation of Neurological Surgeons grade, Hunt-Hess grade, modified Fisher grade, and serum soluble LOX-1 concentrations were comparable (all P > 0.05). ConclusionsSerum soluble LOX-1 appears to have the potential to become a promising prognostic predictor after human aneurysmal SAH.