Seizures Risk Factors And Anemia Predicting Model After Aneurysmal Subarachnoid Hemorrhage

Objectives: 1.Aneurysmal Subarachnoid Hemorrhage(a SAH)is a life-threatening disease associated with high mortality.And seizure is a serious complication of the a SAH.The authors sought to assess whether systemic inflammatory response syndrome(SIRS)was associated with convulsive seizures following a SAH.2.Anemia is a severe and common complication in patients with aneurysmal subarachnoid hemorrhage(a SAH).Early intervention for at-risk patients before anemia occur was indicated to be potentially beneficial,yet no validated method synthesizes patients' complicated clinical features into an instrument.The purpose of the current study was to develop and externally validate a nomogram that predicts post-acute phase anemia after a SAH.Methods: 1.A retrospective analysis of 502 consecutive patients with a SAH was conducted by univariate and multivariate analyses to identify the risk factors for SIRS development and explore the correlation between SIRS and convulsive seizures.Diverse SIRS criteria including early SIRS,delayed SIRS,SIRS burden,early SIRS burden(ESB)and delayed SIRS burden(DSB)were identified.2.We developed a novel nomogram of a SAH patients to predict post-acute phase(defined as 72 hours after a SAH occurred and prior to discharge)anemia on the basis of demographic information,imaging,type of treatment,aneurysm features,blood tests and clinical characteristics.We designed the model from a development cohort and tested the nomogram in an external validation cohort.We assessed the performance of the nomogram via concordance statistics and evaluated the calibration of predicted anemia outcome with observed anemia occurrence.Results: 1.75.7% of a SAH patients had early SIRS,and 78% developed delayed SIRS.Median SIRS burden was 80%(interquartile range,60-100%)in patients with convulsive seizures,and 50%(interquartile range,20-80%)in patients without seizures.World Federation of Neurosurgical Societies(WFNS)admission grade and modified Fisher Scale score were found to be risk factors for both early SIRS and delayed SIRS.In multivariate analysis,delayed SIRS(OR,8.95;95%CI,1.195-67.10),SIRS burden(OR,15.48;95%CI,3.53-67.18),ESB(OR,4.125;95% CI,1.37-12.36)and DSB(OR,9.78;95%CI,2.72-35.21)were significantly associated with convulsive seizures following a SAH.SIRS burden(area under the curve(AUC),0.710;95% CI,0.62-0.80)had a higher predictive value for convulsive seizures compared with other SIRS criteria.2.The development cohort included 456 patients and the validation cohort included 220 patients.According to multicariable analysis,sex(OR=3.67;95%CI =2.27-5.93)?SIRS score on admission(OR=1.48;95%CI=1.20-1.82)?GCS score(OR=0.84;95%CI=0.80-0.89)?treatment method(OR=2.35;95%CI=1.56-3.55)?prothrombin time(OR=1.42;95%CI=1.17-1.72),aneurysm size?10mm(OR=1.98;95%CI=1.04-3.78)?heart rate(OR=1.02;95%CI=1.00-1.03)Variables included in the nomograms were age,treatment method(open surgery or endovascular therapies),baseline hemoglobin level,fasting blood glucose level,SIRS score on admission,GCS score,aneurysm size,prothrombin time and heart rate.In the validation cohort,the model for prediction of post-acute phase anemia had a c-statistic of 0.910,with satisfactory calibration for the predicted and reported anemia outcome.Conclusion: 1.Delayed SRIS,SIRS burden,ESB and DSB but not early SIRS are associated with post-a SAH convulsive seizures.Convulsive seizures onset after a SAH is linked to sustained systemic inflammatory response.2.The developed and validated nomogram can be used to calculate individualized anemia risk and become a practical tool for clinicians to achieve better treatment for a SAH patients.