Study On The Relationship Between Platelet Parameters And Delayed Cerebral Ischemia And Prognosis After ASAH

Objective:To investigate the correlation between platelet parameters and delayed cerebral ischemia(DCI)and poor prognosis after aneurysmal subarachnoid hemorrhage(aSAH),so as to provide evidence for early identification of high risk patients with DCI and poor prognosis after aSAH and early intervention.Methods:A total of 228 aSAH patients who met the inclusion criteria were selected from the Department of Neurosurgery of the affiliated Hospital of North Sichuan Medical College from August 2016 to September 2019.The general data(sex,age,past history,degree of illness at admission,blood pressure and imaging data)and laboratory data were collected,and the modified Rankin scale(mRS score)was used to evaluate the prognosis of the patients for 3 months.Using spss24.0 statistical software,Chi-square test,Fisher exact test,t-test or rank sum test and multivariate Logistic regression analysis were used to determine the risk factors of DCI occurrence and poor prognosis,ROC curve analysis of variable predictive value and determine the threshold.The correlation between mean platelet volume(MPV)and other platelet parameter variables and DCI after SAH was analyzed.Results:Of the 228 patients who met the inclusion criteria,56 developed DCI(about 24.6%)and 82 had a poor prognosis(about 36.0%).Univariate analysis showed that modified Fisher grade,MPV,PVI,PDW were correlated with the occurrence of DCI(p<0.05).Multivariate Logistic regression analysis showed that Modified Fisher grade(95%CI:1.066-4.215,p=0.032)and MPV(95%CI:1.372-3.166,p=0.001)were independently related to the occurrence of DCI.ROC curve analysis of MPV(MPV>11.95fl)could predict the occurrence of DCI after aSAH.The area under the curve is 0.744(95%CI:0.673-0.856,p<0.001,sensitivity:73.2%,specificity:70.3%).In multivariate prognostic analysis,univariate analysis showed that WFNS grade,modified Fisher grade and MPV were correlated with poor prognosis of aSAH patients after 3 months(p<0.05).Multivariate Logistic regression analysis showed that WFNS grade(95%CI:2.579-10.789,p<0.001),Modified Fisher grade(95%CI:1.022-3.977,p=0.043)and MPV(95%CI:1.049-1.546,p=0.015)were independently associated with poor prognosis of aSAH.Spearman correlation analysis showed that MPV level was negatively correlated with PLT(r=-0.499,p<0.001)and positively correlated with PDW(r=0.528,p<0.001).Conclusions:1.MPV has a negative correlation with PLT and a positive correlation with PDW,suggesting that MPV is related to platelet activation after aSAH.2.Platelet parameters are related to the occurrence of DCI after aSAH,in which MPV is independently related to the occurrence of DCI,and when MPV?11.95fl,the risk of DCI is higher.3.PDW and PVI are closely related to the occurrence of DCI,but can not be regarded as independent risk factors.4.MPV can be used as an independent risk factor for the prognosis of poor neurological function in aSAH.