A New Score For Early Predicting The Prognosis Of Patients With Aneurysmal Subarachnoid Hemorrhage After Microsurgical Clipping

Objective:Clipping of cerebral aneurysms is widely performed in the treatment of patients with aneurysmal subarachnoid hemorrhage(a SAH).Although with the progress of time,aneurysm interventional embolization therapy seems to have been gradually replaced its historical status.However,it is still widely used in economically underdeveloped areas,and plays a crucial role in the management of complex aneurysms.Therefore,we hope to create a new scoring system that can accurately predicts the prognosis of patients after clipping by research analysis.Methods:We retrospective analyzed a SAH patients’ general information,preoperative imaging,intraoperative video and postoperative records who underwent aneurysm clipping between January 2013 and December 2017 in the affiliated hospital of zunyi medical university.And according to the modified Rankin Scale(m RS)at 3 months after discharge to divided into a favorable(m RS 0-2)and unfavorable(m RS 3-6)prognosis group.Then we used logistic regression analysis established PARBSE scoring system.Meanwhile,it was used to evaluate the prognosis of a SAH patients who were included in the prospective study between January 2018 and December 2018.As well as compared with other rating scales,plotted respective receiver operating characteristic(ROC)curves,calculated the area under the ROC curve(AUC)respectively to verify its accuracy.Results:We first conducted a retrospective study on 216 aSAH patients and found that 48 patients(22.2%)had poor prognosis.After comparing with good prognosis group,we found the degree of intracranial aneurysm atherosclerosis,age,resuscitation world federation of neurological societies(r WFNS),Barrow neurological institute(BNI),Early Subarachnoid hemorrhage early brain edema score(SEBES)andexternal ventricular drain(EVD)insertion is closely related to the prognosis.And then constructed PARBSE scale based on the magnitude of the odds ratio.Age>75 years,r WFNS score≥4,BNI score≥3,SEBES score≥3,EVD treatment and moderate or severe degree of aneurysm atherosclerosis were rated as 1 point,the score range from0 to 6 and an AUC of 0.935(P < 0.001).Finally,we found when the PARBSE score was rated to 0,1,2,3,4,5 and 6,the rate of poor prognosis was 0%,0%,12.5%,16.7%,72.7%,100% and 100%,respectively.Therefore,PARBSE score ≥ 4considered as a risk factor for poor prognosis.Conclusion:Comparing the PARBSE system with other rating scales for prognostic assessment,we found that PARBSE score is more accurate in predicting the prognosis of patients after microclipping.Perhaps we can apply it widely in clinical work in the future.