A Study On The Risk Factors For The Preoperative Rebleeding In Patients With Ruptured Intracranial Aneurysms

Background and Purpose:Subarachnoid hemorrhage(SAH)is a severe and common disease caused by the rupture of diseased blood vessels at the base of the cerebrum or the surface of it,causing blood to flow directly into the subarachnoid space.85% of SAH is caused by the rupture of intracranial aneurysm.Consequently,preoperative rebleeding after ruptured intracranial aneurysm is considered to be an important cause of mortality and disability after subarachnoid hemorrhage(SAH).Despite the research on the relevant factors of preoperative rebleeding being a hotspot in clinical research,previous studies focused on the general information,condition of patients and aneurysm characteristics.Recently,some researchers have begun to explore the predictive role of hematological indicators in a SAH rebleeding.The purpose of this study was to further investigate the factors associated with preoperative rebleeding after ruptured intracranial aneurysm based on general information of patients,aneurysm characteristics,as well as hematological indicators,and to take targeted clinical preventive measures to help patients obtain a good prognosis.Methods:The study restropectively investigated 804 patients with aneurysm subarachnoid hemorrhage caused by rupture of intracranial aneurysm diagnosed in medical center between January 1,2017 and October 31,2021.Initially,the patients were divided into the rebleeding group and the non-rebleeding group according to the occurrence of preoperative rebleeding.During the time period,the general information,aneurysm imaging characteristics,hematological test indicators within 72 hours of onset and other relevant data of the two groups of patients were collected respectively.Furthermore,the aspect ratio of the aneurysm(the ratio of aneurysm height to tumor neck),and neutrophil percentage-to-albumin ratio(NPAR)were calculated.Eventually,univariate analysis was used to compare whether the differences between the two groups were statistical significance of each indicator,and then the indicators with statistical significance were included in multivariate logistic regression analysis to obtain the factors associated with re-rupture and rebleeding of intracranial aneurysm.The Receiver operating characteristic(ROC)curve was used to analyze the predictive ability of NPAR for re-bleeding.Result:A total of 804 patients were enrolled,of whom the preoperative rebleeding rate was 8.1%(65/804),and the rate of poor prognosis(m RS score > 2)at discharge was 22.8%(183/804),of which the rate of poor prognosis at discharge in the rebleeding group was 44.6%(29/65).Rebleeding occurred in 13 cases(20.0%)on the first day of onset,after that the number of rebleeding in a day was significantly lower than that on the first day.482 cases(59.95%)of the responsible aneurysm were treated within 1 day of admission,702cases(87.31%)within 3 days,751 cases(93.41%)within 1 week,and 19 cases(2.36%)after 1 week),while 34 cases(4.23%)did not choose to undergo surgery.Univariate analysis showed that the ratio of patients with modified Fisher grade ≥ Ⅲ,Hunt-Hess grade≥ Ⅲ,intracranial hematoma,preoperative systolic blood pressure ≥ 160 mm Hg,maximum diameter of aneurysm > 10 mm,aspect ratio > 1.6,irregular aneurysm shape was significantly higher in the rebleeding group than that in the non-rebleeding group.The difference was statistically significant(P < 0.05).Similarly,the percentage of neutrophils and NPAR value in the rebleeding group were significantly higher than those in the non-rebleeding group.The amount of albumin in the rebleeding group was significantly lower than that in the non-rebleeding group,and the difference is statistically significant(P < 0.05).In patients with preoperative rebleeding,the NPAR value in the poor prognosis group is significantly higher than that in the good prognosis group,and the difference is statistically significant(P < 0.05).Multivariate logistic regression analysis revealed that elevated NPAR(OR = 1.252,95% CI:1.148-1.365,P < 0.001),preoperative systolic blood pressure ≥ 160 mm Hg(OR = 2.909,95% CI:1.625-5.208,P < 0.001),intracranial hematoma(OR = 2.136,95% CI: 1.036-4.404,P = 0.040),maximum diameter of aneurysm > 10mm(OR=2.476,95% CI: 1.163-5.272,P = 0.019),and irregular aneurysm(OR= 2.036,95% CI: 1.085-3.822,P = 0.027),all increased the risk of preoperative rebleeding.ROC curve analysis showed that NPAR value within 72 h of onset had certain predictive value for rebleeding.The area under the curve was 0.734(95% CI: 0.668-0.800),and the cut-off value was 22.087,and the sensitivity and specificity of prediction were 60.0% and 82% respectively.Conclusion:1.The incidence of rebleeding in the cases included is 8.1%(65/804),and the first day after the onset is the period of high incidence of rebleeding.2.Increased NPAR,preoperative systolic blood pressure ≥ 160 mm Hg,intracranial hematoma,maximum diameter of aneurysm > 10 mm,and irregular aneurysm can increase the risk of preoperative rebleeding after ruptured intracranial aneurysm.Besides,elevated NPAR is associated with poor prognosis in patients with a SAH rebleeding.