| Background and Objectives:Aneurysmal subarachnoid hemorrhage(aSAH)is a fateful cerebrovascular accident that results in high morbidity and mortality.Identifying risk factors for poor outcome can assist with the management of these patients.Delayed cerebral ischemia(DCI)is one of the most important predictors of unfavorable outcome in aSAH.Secondary hypercoagulability,mediated by increased platelet activation after aSAH,may induce the contraction of arteriole and micro-thrombosis.Microthrombus in the specific area of brain affects the blood supply and deteriorates the neurological function,which leads to the occurrence of DCI.The activation and aggregation of platelets are associated with micro-thrombosis and DCI.Therefore,we should pay attention to the functional status of platelets in aSAH patients.The recurrence of aneurysm is another hot topic.The histological mechanism of aneurysm healing following embolization is a process of thrombosis,inflammatory cell invasion and neointima formation.The formation of early thrombus provides a provisional matrix to allow recruitment of cells involved in the aneurysm-healing process.Complete thrombus organization is associated with improved neointima formation and healing,while the instability of an unorganized thrombus may lead to the recurrence of aneurysm.Therefore,the functional status of platelets is also associated with the recurrence of aneurysm.Mean platelet volume(MPV)reflects the average size of platelets.It is associated with the function and activation of platelets and reflects the thrombotic potential of patients.Based on the fact that the two hotspots in aSAH are both associated with the function of platelets,we speculate that MPV may be associated with the prognosis,occurrence of DCI,and aneurysm recurrence in aSAH.The purpose of this study is:1.To assess whether MPV is associated with the functional outcome of aSAH patients.2.To explore the temporal variation of MPV and its association with the occurrence of DCI in aSAH patients.3.To explore the relationship between the MPV and aneurysm recurrence in aSAH patients who received endovascular treatment.4.To evaluate the effects of dual antiplatelet therapy(DAPT)on DCI and MPV value in aSAH patients.Methods:1.We retrospectively collected and analyzed data of aSAH patients that received treatment in our institution between January 2015 and January 2020.The MPV value was collected and measured on admission.Patients were divided into two groups according to the modified Rankin Scale(mRS)score at 3 months.An mRS score of ≤2 was defined as a favorable outcome,while a score of >2 was defined as a unfavorable outcome.Univariate analysis and multivariate logistic regression analysis were performed to investigate the relationship between MPV and functional outcome in aSAH.The receiver operating characteristic(ROC)curve analysis was performed to indicate the predictive value of MPV for functional outcome and to determine the best cut-off value.2.We retrospectively collected and analyzed data of aSAH patients that received treatment in our institution between January 2017 and January 2020.Blood samples to assess MPV were obtained at 1-3,3-5,5-7,and 7-9 d after the initial hemorrhage.Univariate analysis and multivariate logistic regression analysis were performed to investigate whether MPV was an independent predictor of DCI.The ROC curve was determined to assess the overall discrimination ability of MPV to predict DCI.3.We retrospectively collected and analyzed data of aSAH patients that received endovascular treatment in our institution between January 2015 and January 2020.Blood samples to assess MPV were obtained on admission before the initial treatment.All aneurysms were divided into two groups based on aneurysm recurrence.Univariate analysis and multivariate logistic regression analysis were performed to investigate whether MPV was an independent predictor of aneurysm recurrence.The ROC curve and area under the curve(AUC)were determined.4.We retrospectively collected and analyzed data of aSAH patients that received endovascular treatment in our institution between January 2019 and December 2021.Blood samples to assess MPV were obtained at 1-3,3-5,5-7,and 7-9 d after the initial hemorrhage.Patients were divided into two groups: patients who underwent stentassisted coiling requiring DAPT(DAPT group)and patients who underwent coiling only or balloon-assisted coiling without DAPT(control group).The risk of DCI,hemorrhagic complications and MPV values were compared between the two groups.Results:Tongji University Doctor of Clinical Medicine Abstract1.262 patients were included in the first part.At the 3-month follow-up,193(73.7%)patients received favorable outcomes(mRS≤2),and 69(26.3%)patients received poor outcomes(mRS>2).The univariate analysis indicated that patients with poor functional outcome had higher MPV values compared to those with favorable outcome(11.2 [10.7-12.0] vs.10.1 [9.4-10.5],P<0.001).Multivariate logistic regression analysis revealed that MPV was an independent predictor of poor functional outcome(odds ratio [OR]: 2.960,95% confidence interval [CI]: 1.738-5.041,P<0.001).ROC analysis revealed that MPV level could predict poor outcome with an AUC of0.803(95%CI: 0.739-0.867,P<0.001).When setting 10.65 f L as the best cut-off value,we found that an MPV ≥10.65 f L had a sensitivity of 75.4% and specificity of 79.3%for the prediction of poor outcome.Patients with higher MPV value on admission(MPV≥10.65 f L)tended to have higher Hunt-Hess grade,higher Fisher grade,higher proportion of acute hydrocephalus,shunt-dependent hydrocephalus,delayed cerebral ischemia and higher mortality(P<0.05).2.197 patients were included in the second part.58(29.4%)patients developed DCI.The MPV values in patients with DCI were significantly higher than those without DCI at 1-3,3-5,5-7,and 7-9 d after hemorrhage(P < 0.001).The trend for MPV in patients with DCI was increased at first and then decreased.The transition from increases to decreases occurred at 3-5 d after hemorrhage.The optimal cut-off value for MPV to predict DCI was 10.35 f L at 3-5 d after aSAH,with a sensitivity of 79.3% and a specificity of 80.6%.Multivariate logistic regression analysis indicated that the MPV observed at 3-5 d was an independent risk factor for DCI(OR =4.474,95% CI: 2.693-7.434,P<0.001).3.204 aneurysms in 187 aSAH patients were included in the third part.A total of42(20.6%)aneurysms exhibited recurrence.Aneurysms with recurrence had a lower rate of complete obliteration(P=0.002)and lower MPV values on admission(P <0.001)compared to aneurysms without recurrence.The multivariate logistic regression analysis showed that the Raymond-Roy classification(OR: 3.217,95% CI: 1.308-7.913,P =0.011)and MPV(OR: 0.247,95% CI: 0.151-0.402,P <0.001)were significantly associated with aneurysm recurrence.The ROC curve analysis determined that MPV could predict aneurysm recurrence with an AUC of 0.846(95% CI: 0.788-0.892,P<0.001).The optimal cut-off value for MPV to predict aneurysm recurrence was 9.9 f L.An MPV ≤9.9 f L could predict aneurysm recurrence with a sensitivity of 80.9% and a specificity of 79.6%.4.186 patients were included in the fourth part.64 patients underwent stentassisted coiling requiring DAPT,and 122 patients underwent coiling only or balloonassisted coiling without DAPT.The risk of DCI was significantly lower in patients receiving DAPT compared with those in control group(14.1% [9/64] vs.27.0%[33/122],P =0.044).The rate of hemorrhagic complications was similar in both groups(3.1% [2/64] vs.0.8% [1/122],P =0.236).There was no difference in MPV values obtained at 1-3,3-5,5-7,and 7-9 d after the initial hemorrhage between the two groups(P>0.05).Conclusions:1.MPV is an independent predictor of unfavorable outcome at 3 months in aSAH patients,patients with higher MPV on admission tend to have poorer functional outcome than patients with lower MPV.2.MPV is a dynamic variable that occurs during aSAH.The trend for MPV in patients with DCI is increased at first and then decreased.A high MPV at 3-5 days after hemorrhage is independently associated with the development of DCI.3.MPV can predict aneurysm recurrence in aSAH patients who receive endovascular treatment,patients with lower MPV are at higher risk of aneurysm recurrence.Therefore,MPV can be used in clinical settings to screen patients at high risk for aneurysm recurrence.4.The use of DAPT is associated with a lower risk of DCI in aSAH patients following endovascular treatment,and the MPV value is not affected by DAPT. |
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