Association Between Blood Lipids With Clinical Prognosis Of Aneurysm Subarachnoid Hemorrhage

Objective To analyze and compare the admission blood lipid levels of aneurysmal subarachnoid hemorrhage(aSAH)patients with good functions and poor functions groups.To investigate the correlation between lipids and the level of neurological function recovery in aSAH patients.Combining serum lipid parameters and other indicators related to the patient’s clinical prognosis to construct a Nomogram model that can predict the prognosis of patients’ neurological function.Methods Among the patients with aSAH who received endovascular treatment,a total of 213 people met the study criteria.Basic data of each subject were collected,and Hunt-Hess grade was evaluated according to patients’ state of consciousness at admission.According to the results of the first CT examination after admission,the modified Fisher scale was evaluated and recorded.The characteristics(location,size)of ruptured aneurysms were recorded based on DSA results.The counts of various white blood cells in routine blood tests within 24 hours after the onset of the disease were recorded,and by calculating the equation to get the inflammation index NLR,MLR,SIRI value.24 hours after admission,5ml of venous blood was collected and sent to the laboratory for testing to detect and record blood lipid-related indicators,including various types of cholesterol and free fatty acids related to lipids in serum.non-HDL-C and non-HDL-C/HDL-C were obtained by calculation.The level of neurological recovery was assessed according to the modified Rankin scale(m RS)score at discharge(m RS<3 is classified as a good prognosis,and m RS≥3 is classified as a poor prognosis).Preliminary screening of risk factors that may affect the patient’s functional prognosis through univariate analysis.Spearman analysis to test the correlation between the level of blood lipid and the extent of aSAH.In order to screen out the risk factors that could really affect the prognosis of patients,Logistic regression was used to explore the variables that differed between patients with different prognosis.And construct nomogram model that includes each independent risk factors.Establishing receiver operating characteristic curve based on this model to evaluate the reliability of the model and predict the prognosis of poor function.Results(1)The results of univariate analysis reflect there was no statistical disparities in sex composition,incidence of diabetes,smoking,aneurysm size,routine lipid indexes and non-HDL-C/HDL-C(P>0.05).The two groups are obviously different in mean age of addmission(t=-4.027,P<0.001),whether they had hypertension(χ2=6.831,P=0.009),the Hunt-Hess grade at admission(χ2=35.270,P<0.001),the modified Fisher scale(χ2=47.040,P<0.001),location of responsible aneurysm(χ2=6.494,P=0.011)and serum FFA level after onset(Z=-2.523,P=0.012).(2)Correlation analysis showed that FFA was correlated with Hunt-Hess grade when the patient was admitted(r=0.141,P=0.04).Correlation analysis between FFA and NLR,MLR,SIRI showed that serum FFA and NLR(r=0.203,P=0.003),MLR(r=0.16,P=0.018),SIRI(r=0.21,P=0.002)are closely correlated.(3)According to the results of the separate analysis of each variable,variables that could potentially affect the functional prognosis of aSAH patients were included in the regression analysis,and stepwise Logistic analysis was performed.The result reflect older patients had a significantly increased risk of poor functional outcomes(OR:1.0,95%CI:1.0 ～1.1,P=0.034).Compared with Hunt-Hess grade I-II,patients with grade III-V have significantly increased risk of poor prognosis(OR:3.6,95%CI:1.8～7.8,P<0.001).Significantly different from the modified Fisher scale I-II,patients with grade III-IV more likely to have poor clinical recovery(OR:6.0,95%CI: 2.9 ～ 12.5,P<0.001).Compared with anterior circulation aneurysm,posterior circulation aneurysm rupture increases the risk of poor function prognosis(OR:4.4,95%CI:1.3～15.1,P=0.018).Patients with higher the serum FFA had higher risk of poor prognosis(OR:3.0,95%CI:1.2～7.8,P=0.021).(4)Combined with FFA and other significant clinical indicators that can independently affect the prognosis of patients with aSAH to construct a Nomogram model that can predict the risk of poor functions.Hosmer-Lemeshow was used to test the degree of fit of the analysis model,with P=0.763,indicating that the model constructed in this study has a good degree of fit.and the ROC proves this model has high specificity and sensitivity(AUC=0.831,95%CI: 0.778～0.885,P<0.001).Conclusions The FFA is closely correlated with the poor function of patients with aSAH.FFA independently affects the outcome of aSAH patients receiving endovascular therapy.The Nomogram prediction model combined with FFA and other clinical indicators has good predictive value for the prognosis of poor function in patients with aSAH.