Association Of Dynamic Level Of Serum Amyloid Proteinase A With Outcomes In Aneurysmal Subarachnoid Hemorrhage

Objective: Subarachnoid hemorrhage(SAH)is a neurological disease which seriously threatens human life and health.It has a high mortality and incidence rate.Most of the surviving patients will also suffer from severe neurological impairment.Intracranial aneurysm rupture is the main cause of SAH.In recent years,with the maturity of aneurysm clipping or interventional embolization technology and the wide popularization of neurointensive care management,the mortality of SAH has decreased by about 50%.However,the permanent neurological,cognitive or functional defects caused by SAH to survivors make them unable to return to work,which places a serious burden on families and society.At present,a large number of studies have shown that the main cause of delayed neurological deterioration after SAH is systemic inflammation.Serum amyloid proteinase A(SAA),as an inflammatory index used to evaluate the progress of acute and chronic inflammation in clinic,has not been reported whether it participates in the systemic inflammatory response and the formation of delayed cerebral ischemia(DCI)after SAH,and whether it affects the long-term prognosis of SAH patients.The purpose of this study is to explore the correlation between SAA concentration and neurological prognosis in SAH patients.The secondary objective is to explore the correlation between SAA concentration and DCI,infectious diseases,hydrocephalus and other complications during hospitalization.Methods: This study prospectively observed the patients who were diagnosed as aneurysmal subarachnoid hemorrhage and received unified standard treatment in the Department of Neurosurgery of the Affiliated Hospital of Southwest Medical University from August to November 2021.The levels of SAA obtained by patients on admission,day 3 and day 5 were collected,and the clinical,laboratory,imaging diagnosis and treatment related data were also collected.The main outcome was the neurological status of patients at 3-month follow-up,which was evaluated by modified Rankin Scale(m RS).Favorable results were defined as an m RS score of 0-3.A binary logistic regression model was used to determine the association between the level of SAA and prognosis,including m RS and DCI.Finally,the subject working characteristic curve analysis was used to evaluate the accuracy of the effect of blood SAA level on prognosis.Results: The 100 SAH patients collected,84(84%)were included in the final study.Of these patients,57(65.5%)had a good prognosis of neurological function(MRS score of 0-3).However,27(34.5%)had poor neurological prognosis(MRS score of 4-6).On the third and fifth day after admission,the median levels of SAA in the group with poor neurological prognosis were300 mg / L and 285.9mg/l,respectively,which were significantly higher than127.29mg/l and 66.59mg/l in the group with good neurological prognosis(P =0.003 and P < 0.001,respectively).Binary logistic regression analysis showed that SAA level and hunt Hess grade on the fifth day were the main factors affecting the poor prognosis of neurological function(P = 0.021 and P < 0.001).After that,the receiver operating characteristic curve(ROC curve)was analyzed to evaluate the correlation with adverse neurological prognosis.The results showed that in the early stage after the onset of SAH,the level of SAA was positively correlated with the adverse prognosis of patients.On the fifth day,the level of SAA(AUC: 0.8242,95% CI: 0.5725 – 0.8219)had a more significant impact on the adverse neurological prognosis of patients,And when the SAA level exceeds 220.5mg/l,it has the highest sensitivity and specificity for poor prognosis(sensitivity 77.8%,specificity 84.2%).In addition,the level of SAA on the fifth day was significantly correlated with the occurrence of DCI(P = 0.01,95% CI: 1.002-1.014).Conclusion: The increasing trend of early SAA level in patients with aSAH is significantly related to the poor prognosis of neurological function and the occurrence of DCI.Therefore,early measurement of SAA level may be one of the reference factors to adjust the follow-up neurological function monitoring and treatment of aSAH patients.