| Objective:To explore the predictive value of Systemic immune-inflammation index(SII)on the occurrence of DCI after aneurysmal subarachniod hemorrhage(a SAH)at admission,and draw a monogram to predict the probability of Delayed cerebral ischemia(DCI)in patients with a SAH..Method:Retrospective analysis was performed on patients hospitalized with aneurymatic subarachnoid hemorrhage from July 2017 to March 2021.A total of 146 patients were included according to inclusion and exclusion criteria,and baseline clinical data were collected.According to the diagnostic criteria of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage,the patients were divided into two groups(43 cases in delayed cerebral ischemia group and 103 cases in non-delayed cerebral ischemia group).First,variable conversion and assignment were performed on the two sets of baseline data,and then descriptive statistical analysis and inter-group comparison were performed on the processed data.Receiver operating characteristics(ROC)curve was used to evaluate the predictive ability of SII index at admission and determine the cut-off point threshold.Then,single factor binary logistic regression analysis was conducted to find the predictors of DCI after a SAH.significant variables in univariate binary logistic regression and Intergroup comparison of baseline were integrated,and incorporated it into the multivariate binary logistic regression to adjust confounding factors and to find the independent risk factors of DCI after a SAH.Finally,ROC curve analysis was conducted on the corrected SII model,and compared the prediction ability of significant variables in univariate binary logistic regression and intergroup comparison of baseline and corrected SII model.Then,the binary logistic regression equation was used to draw the monogram.Result: In the intergroup comparison of baseline data,GCS score,Hunt-hess grading,WFNS grading,modified Fisher grading,absolute lymphocyte counts,absolute neutrophil counts,and SII index were statistically different in the occurrence of DCI after a SAH(P < 0.05).ROC curve analysis results showed that the optimal cut-off value of SII index was 1842.87×10^9/L,Yoden index =0.306,sensitivity was 79.1%,specificity was 51.5%(AUC[95%CI]0.638[0.541 ～ 0.734];P=0.009).In univariate analysis logistic regression,GCS score,Hunt-hess scale,WFNS scale,modified Fisher scale,absolute lymphocyte counts and SII index were correlated with delayed cerebral ischemia(P < 0.05).SII index remained an independent predictor of delayed cerebral ischemia(OR=6.072,P=0.009)after multivariate bivariate logistic regression analysis adjusted for significant variables in univariate binary logistic regression and baseline data.The modified SII model showed significant improvement in distinguishing delayed ischemia with a Yoden index of 0.425,a sensitivity of 93% and a specificity of 49.5%(AUC [95%CI]0.743[0.66-0.826];P < 0.001).Conclusion:(1)By univariate and multivariate binary logistic regression analysis,the systemic immune inflammatory index at admission was an independent risk factor for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.(2)According to the corrected SII model and monogram,the severity assessment of clinical symptoms and signs at admission(GCS score,Hunt-hess scale,WFNS scale),laboratory results(absolute neutrophil counts,absolute lymphocyte counts,SII index),and imaging severity assessment(modified Fisher scale)can improve the delayed onset of aneurysmal subarachnoid hemorrhage Accuracy of prediction of sexual cerebral ischemia. |
