The Analysis Of The Factors Correlated To Severity And Prognosis In Patients With Aneurysmal Subarachnoid Hemorrhage

Objective:To investigate the factors related to the severity and prognosis of aneurysmal subarachnoid hemorrhage(aSAH).To determine the correlation between peripheral blood neutrophil/lymphocyte ratio(NLR)and aSAH.Methods:The clinical data,imaging data,laboratory data,Glasgow outcome scale of 171 patients who diagnosed with aSAH in Zhongda Hospital Affiliated Southeast University from April 1,2008 to November 30,2016 were analyzed retrospectively.The correlation between the data above and clinical/radiology grade were analyzed.The prognosis of conservative treatment,endovascular treatment and surgical treatment were analyzed,as well as factors related to prognosis of endovascular and surgical treatment.Results:The female aSAH patients were 1.76 times more than men patients;The patients had the highest incidence at 50-59 years old;The average blood pressure was 152.99/86.77mmHg;Imaging showed that 74.9%of patients only had 1 IA,and the 70.2%of ruptured IA was between 3mm to 10mm;The IA mainly located in anterior or posterior communicating arteries(45.33%).Among 171 aSAH patients,23 patients transferred to other hospital.The rest 148 patients divided into three groups(conservative treatment group,endovascular treatment group,surgical treatment group)according to the different therapy method.Conservative treatment group included 44 patients who had 56 IA.26 cases(59.40%)had favorable outcome(GOS score 3-5),3 cases(6.50%)had poor outcome(GOS score 1-2),15 cases(34.10%)died.Endovascular treatment group included 68 cases with 89 IAs.49 patients(72.06%)received coiling alone,19 cases(27.84%)received stent-assisted coiling.61 cases(89.71%)received dense coiling.45 cases(66.20%)had favorable outcome,23 cases(33.80%)had poor outcome,11 cases(16.20%)died.Surgical treatment group included 36 cases with 51 IAs.32(88.89%)were performed with clipping of aneurysm,3(8.33%)were performed with clipping of aneurysm and wrapping of aneurysm,1(2.78%)was performed with wrapping of aneurysm.25 cases(69.44%)had favorable outcome,7(19.45%)had poor outcome,4(11.11%)died.Univariate analysis showed that age,SBP,DBP,cerebral infarction history,IA position,adjuvant treatment,central nervous system infection,hospital stay,and death toll were significant among the three groups(p<0.05).Hunt-Hess scale,WFNS scale and modified Fisher CT scale were linearly correlated with each other.In addition to the above scales,the factors related to severity of clinical manifestations were blood glucose,NLR,neutrophil count,leukocyte count and creatinine(P<0.05).The factors related to severity of imaging were NLR,blood glucose,neutrophil count,leukocyte count.Univariate analysis showed that age,Hunt-Hess scale,WFNS scale,conscious disturbance,modified Fisher CT scale,intraventricular hemorrhage,IA number,leukocyte count,neutrophil count,NLR,creatinine,blood glucose and neurological complications affected prognosis.Multivariable analysis showed that Hunt-Hess scale,NLR,blood glucose and neurological complications were associated with prognosis.The area under the ROC curve of NLR(0.726)is larger than blood glucose(0.712);NLR cutoff value was 16.23,sensitivity was 50.00%,specificity was 91.18%.Conclusion:(1)Endovascular treatment or surgical treatment can lower death rate,while the efficacy of endovascular treatment or surgical treatment are resemble.(2)aSAH clinical grading scales and imaging scales are mutually linear correlated.NLR and blood glucose reflect the severity of aSAH.(3)Hunt-Hess scale,blood glucose,NLR and neurological complications are independent predictors of prognosis for aSAH patients who undergo endovascular or surgical treatment.(4)NLR has predictive value for aSAH condition and prognosis.