| Background and Objective:Subarachnoid hemorrhage(SAH)is a devastating cerebrovascular disease,and the SAH caused by aneurysm rupture accounts for about 85%,causing huge losses to individuals,families and society.In recent years,the early diagnosis and treatment of patients with aneurysmal subarachnoid hemorrhage(a SAH)and predicting their clinical prognosis have gradually attracted more attention.There is increasing evidence that inflammatory mechanisms are involved in brain injury caused by a SAH.The serum inflammatory factors at admission have been used to predict delayed cerebral ischemia(DCI)and clinical prognosis of a SAH.In this study,we mainly evaluated the relationship between C-reactive protein to lymphocyte ratio(CLR)and postoperative DCI and poor prognosis in patients with a SAH.Methods:We retrospectively analyzed the clinical data of 221 patients with a SAH,who were admitted to the intensive care unit of Henan Provincial People ’s Hospital from January 2017 to December 2021.The indicator of inflammatory factors in the first routine blood examination within 48 h bleeding was obtained.The prognosis was evaluated by modified Rankin Scale(m RS)score at discharge,m RS>2 was a poor outcome.According to the presence of postoperative DCI,they were divided into DCI group and non-DCI group.Through the receiver operating characteristic(ROC)curve,the area under the curve was calculated,and the area of various inflammatory indicators in the blood was compared to obtain the best indicator.Univariate and multivariate logistic regression analyses were used to evaluate the relationship between CLR and the clinical prognosis of the patients.ROC curve analysis was performed to determine the optimal cut-off threshold,sensitivity,and specificity of CLR in predicting prognosis on admission.Results:According to the m RS score at discharge,82 patients were divided into good outcome(m RS≤2),139 patients were divided into poor outcomes(m RS>2),included 14 deaths.The patients were divided into DCI group(53 cases)and non-DCI group(168 cases).Univariate analysis showed that diabetes,hypertension,cerebral infarction,treatment,modified Fisher score ≥ 3,Hunt-Hess grade > 3 were significantly higher in the poor prognosis group than in the good prognosis group,and the difference was statistically significant(P < 0.05).Age,white blood cells,neutrophils,percentage of neutrophils,CRP,NLR,and CLR values were significantly higher in the poor outcome group than in the good outcome group,and eosinophils and lymphocytes were significantly lower in the poor outcome group than in the good outcome group.The difference was statistically significant(P < 0.05).The CLR value of the poor outcome group(35.92±41.67)was higher than that of patients in the good outcome group(4.44±7.74),and the difference was statistically significant(P<0.05).Univariate analysis of DCI group and non-DCI group found that smoking,drinking,coronary heart disease,hypertension,Fisher score≥3,Hunt-Hess>3 in DCI group was significantly higher than that in non-DCI group(P < 0.05).The values of WBC,CRP,NLR and CLR in DCI group were significantly higher than those in non-DCI group,and the differences were statistically significant(P < 0.05).Multivariable Logistic regression analysis showed that the Modified Fisher grade,Hunt-Hess grade,therapy,and CLR at admission were independent risk factors for poor outcomes of patients with a SAH(P<0.05).The inflammatory factor with the best predictive value was CLR,which had an optimal cut-off threshold of 10.81 and an area under the ROC curve of 0.840(95% CI 0.788-0.892,P<0.001).CLR was also an independent risk factor for DCI in a SAH patients,with the optimal cut-off value for CLR being 31.57 and the area under the ROC curve being 0.791(95% CI 0.698-0.866,P<0.001).According to Hunt-Hess grade,patients were divided into a mild group(Hunt-Hess≤3)and a severe group(Hunt-Hess>3),and the CLR value was significantly higher in severe patients(33.96±44.85)with a SAH than in mild patients(18.39±29.36).The univariate analysis of the severe group found that the poor outcome in the severe group was generally higher age than the good outcome group,and the CLR value in the poor outcome group(38.20±46.24)was higher than the CLR value in the good outcome group(2.94±2.05),a statistically significant difference(P<0.05).Comparing the DCI group with the non-DCI group,it was found that there were significant differences in gender,smoking and coronary heart disease between a SAH patients in the severe group(P<0.05).The WBC,CRP,NLR and CLR values in the DCI group were significantly higher than those in the non-DCI group,and the difference was statistically significant(P < 0.05).The CLR value of the DCI group(67.29±55.44)was significantly higher than that of the non-DCI group(15.09±21.31).In multivariate logistic regression analysis,it was found that the risk of poor outcome of surgical clipping was significantly higher than that of endovascular treatment,and the inflammatory index CLR was still an independent risk factor for poor outcome in patients with severe a SAH.Coronary heart disease and CLR are independent risk factors for DCI in patients with a SAH.In the ROC curve analysis,based on good and poor outcome in the severe group(Hunt-Hess>3),the WBC,neutrophils,CRP,and CLR values of patients in the severe group(Hunt-Hess>3)were 0.715,0.692,0.817,and 0.838,respectively.The optimal cut-off threshold of CLR was 6.87,the area under the ROC curve was 0.838(95% CL 0.752-0.925,P<0.001).Based on the severe group(Hunt-Hess>3)in the DCI and non-DCI groups,the WBC,neutrophils,CRP,NLR,and CLR were 0.634,0.632,0.0.795,0.631,and 0.808,respectively.CLR predicted the highest accuracy for clinical outcome in patients with a SAH.The optimal cut-off value for CLR was 31.57,and the area under the ROC curve was 0.808(95% CL 0.698-0.917,P<0.001).Conclusions:The prognosis of patients with a SAH was significantly correlated with Hunt-Hess grade.The higher the Hunt-Hess grade,the higher the CLR value,the worse the prognosis of patients,and the higher the risk of DCI.Early CLR values can be used as novel biomarkers to predict the clinical prognosis and the risk of developing DCI in patients with a SAH. |
PDF Full Text Request