Analysis Of Risk Factors For Poor Prognosis In Patients With Aneurysmal Subarachnoid Hemorrhage Treated With Thrombectomy And The Value Of Early Cerebrospinal Fluid Lactate Levels In Predicting Prognosis

Objective: To analyze the risk factors influencing the prognosis of patients after endovascular embolization for aneurysmal subarachnoid hemorrhage(aSAH)and to explore the correlation between early cerebrospinal fluid lactate levels and patient prognosis,in order to investigate the risk factors affecting the prognosis of patients after aSAH embolization and the value of early cerebrospinal fluid lactate levels in patient prognosis.Methods:(1)A retrospective analysis was conducted using the interventional embolization surgery cases of aneurysmal subarachnoid hemorrhage(aSAH)admitted to the Affiliated Hospital of Youjiang Medical University for Nationalities from September 1,2021,to August 31,2022,based on the latest diagnostic criteria.A total of 105 case records were collected.(2)Follow-up was conducted at 3 months post-surgery,and the Modified Rankin Scale(m RS)was used to assess the functional outcome of aSAH patients.Scores ranging from 0 to 2 were categorized as good prognosis,while scores from 3 to 6 were classified as poor prognosis.Based on the scores,patients were divided into the m RS good prognosis group and the m RS poor prognosis group.(3)Follow-up was also performed at 3 months post-surgery,and the Glasgow Outcome Scale(GOS)was used for scoring.Scores of 4 or 5indicated a good prognosis,while scores of 1 to 3 indicated a poor prognosis.Based on the scores,patients were divided into the GOS good prognosis group and the GOS poor prognosis group.(4)Cerebrospinal fluid samples were collected within 24 hours after surgery,and the lactate content in the CSF was measured.Statistical analysis was performed to determine the significance of lactate levels and their correlation with patient prognosis.(5)Univariate analysis was used to identify significant factors,followed by multivariate logistic regression analysis to determine the independent risk factors.The independent risk factors influencing surgical prognosis were summarized.Receiver Operating Characteristic(ROC)curves were plotted,and the Area Under the Curve(AUC),sensitivity,and specificity were calculated to analyze the correlation between early postoperative CSF lactate levels and patient prognosis.Significant statistical data were input into Graph Pad Prism 9,a visualization software,to create informative data plots.Results:(1)Univariate analysis of the GOS group showed that patients in the GOS poor prognosis group had a higher incidence of hydrocephalus and aneurysmal re-rupture compared to the GOS good prognosis group.Additionally,patients in the GOS poor prognosis group had higher age,Hunt & Hess scores,and cerebrospinal fluid lactate levels compared to the GOS good prognosis group.(2)Univariate analysis of the m RS group showed that patients in the m RS poor prognosis group had a higher incidence of pneumonia and aneurysmal re-rupture compared to the m RS good prognosis group.Furthermore,patients in the m RS poor prognosis group had higher age and cerebrospinal fluid lactate levels compared to the m RS good prognosis group.Conclusion:(1)Age,early cerebrospinal fluid lactate levels,and the presence of re-ruptured aneurysm are independent risk factors influencing the prognosis of patients after interventional embolization for aSAH.(2)Early cerebrospinal fluid lactate levels have a good predictive value for the prognosis of patients after interventional embolization for aSAH.