Study On The Risk Factors Of Rebleeding In Acute Stage Of Ruptured Intracranial Aneurysm

Objective: In the aneurysmal subarachnoid hemorrhage(a SAH),the number of neutrophils,the number of lymphocytes,the ratio of neutrophils to lymphocytes(NLR),the clinical and imaging manifestations(including Hunt Hess classification and improved m Fisher classification)and other commonly used clinical indicators are related to the rupture and rebleeding of aneurysms.Methods: A retrospective analysis was made of 508 patients in the First Affiliated Hospital of Fujian Medical University from January 2009 to December 2019,who met the inclusion criteria.The clinical data of patients with ruptured aneurysm bleeding were collected.The patients were divided into rebleeding group and non rebleeding group according to whether they had rebleeding within 72 hours.The age,gender,basic diseases,vascular risk factors(Hypertension,Diabetes Mellitus,Smoking and Drinking),aneurysm size,aneurysm distribution,blood routine,neutrophil lymphocyte ratio(NLR),hunt Hess grade,m RS score,modified m Fisher score.The criteria of m RS prognosis were poor prognosis(> 2 points)and good prognosis(< 2 points).Statistical analysis of these factors was used to predict the clinical value of bleeding and rebleeding of aneurysm rupture during hospitalization,and the correlation between these clinical indicators and prognosis was observed.Results: Among 508 patients with ruptured aneurysm,20(3.94%)had spontaneous rupture bleeding during hospitalization.In this study,20 cases satisfying the conditions were selected as the experimental group and the rest as the control group.In univariate analysis,there was no significant difference between the two groups in gender,age,smoking history,alcohol consumption,diabetes,hypertension,aneurysm location,number,PLT,FIB,Hunt-Hess(P > 0.05).In multivariate analysis,NLR > 9.88(OR6.342,95%CI 1.033-38.951,P = 0.046)and improved m Fisher’s score(OR4.014,95% CI1.195-13.479,P = 0.025)were independent risk factors for rebleeding.In multivariate analysis,NLR > 9.88(OR6.342,95% CI 1.033-38.951,P= 0.046)and improved m Fisher score(OR4.014,95% CI 1.195-13.479,P =0.025)were independent risk factors for rebleeding.The AUC of NLR was0.794,the sensitivity was 85.00% and the specificity was 70.29% when NLR was 9.88(the best threshold);the AUC of improved m Fisher classification was 0.740,the specificity was 60.66% and the sensitivity was 80% when m Fisher was more than 2.The area under ROC curve(AUC)of the improved m Fisher NLR is 0.79.When the value is 0.023,the specificity is 52.05%,and the sensitivity is 100%.Three months after discharge,the patients with poor prognosis(m RS3-6)accounted for 50%(10 / 20),which was significantly higher than that of the patients without re rupture(P < 0.05),while most of the patients in the group without re rupture had a good prognosis,accounting for 87.3%(426 / 488),that is rebleeding was significantly related to the prognosis.NLR and improved m Fisher classification were independent risk factors for rebleeding of ruptured aneurysm.Conclusion:1.NLR The improved m Fisher classification was used as an independent risk factor for rebleeding of ruptured aneurysms.2.Higher NLR can predict the occurrence and adverse outcome of rebleeding after a SAH,and NLR combined with m Fisher score can significantly improve the prediction of rebleeding after a SAH.3.Rebleeding is significantly related to the prognosis of patients,which indirectly indicates that it is higher than the normal value six point four three four Chronotropic NLR is associated with patient prognosis.