Departments of1Emergency and Critical Care Medicine and.
2Department of Neurosurgery, Chiba Hokusoh Hospital, Tokyo, Japan.
J Neurosurg. 2018 Oct;129(4):870-875. doi: 10.3171/2017.5.JNS162799. Epub 2017 Nov 17.
Aneurysmal subarachnoid hemorrhage (SAH) can result in poor outcomes, and biomarkers for predicting poor prognosis have not yet been established. The aim of this study was to clarify the significance of the serum glucose/potassium ratio for predicting the prognosis of aneurysmal SAH.
The authors retrospectively reviewed the records of 565 patients with aneurysmal SAH between 2006 and 2016. The patient group comprised 208 men and 357 women (mean age 61.5 years, range 10-95 years). A statistical analysis was conducted of the clinical and laboratory risk factors of poor outcome, including the serum glucose/potassium ratio.
On estimation of the initial assessment using Hunt and Kosnik (H-K) grading, 233 patients (41.2%) were classified as the severe SAH group (H-K Grade IV or V). There were significant correlations between the severe SAH group and serum glucose/potassium ratio (p < 0.0001). Serum glucose/potassium ratio was elevated in an H-K grade-dependent manner (Spearman's r = 0.5374, p < 0.0001). With the estimation of the Glasgow Outcome Scale (GOS) score at discharge, 355 patients (62.8%) were classified as poor outcome (GOS score 1-3). The serum glucose/potassium ratio was elevated in a GOS score at discharge-dependent manner (Spearman's r = 0.4006, p < 0.0001), and was significantly elevated in the poor outcome group compared with the good outcome group (GOS score 4 or 5; p = 0.0245). There were significant correlations between poor outcome and serum glucose/potassium ratio (p < 0.0001), age (p < 0.0001), brain natriuretic peptide levels (p = 0.011), cerebral infarction due to vasospasm (p < 0.0001), and H-K grade (p < 0.0001). Multivariate logistic regression analyses showed significant correlations between poor outcome and serum glucose/potassium ratio (p = 0.009).
In this study, the serum glucose/potassium ratio of patients with aneurysmal SAH at admission was significantly correlated with H-K grade and GOS score at discharge. Therefore, this ratio was useful for predicting prognosis of aneurysmal SAH, especially in severe cases.
蛛网膜下腔出血（SAH）可导致预后不良，目前尚未确定用于预测不良预后的生物标志物。本研究旨在阐明血清葡萄糖/钾比值对预测动脉瘤性 SAH 预后的意义。
作者回顾性分析了 2006 年至 2016 年间 565 例动脉瘤性 SAH 患者的记录。患者组包括 208 名男性和 357 名女性（平均年龄 61.5 岁，范围 10-95 岁）。对包括血清葡萄糖/钾比值在内的不良预后的临床和实验室危险因素进行了统计学分析。
根据 Hunt 和 Kosnik（H-K）分级的初始评估估计，233 例患者（41.2%）被归类为严重 SAH 组（H-K 分级 IV 或 V）。严重 SAH 组与血清葡萄糖/钾比值之间存在显著相关性（p<0.0001）。血清葡萄糖/钾比值呈 H-K 分级依赖性升高（Spearman r=0.5374，p<0.0001）。根据出院时格拉斯哥预后评分（GOS）估计，355 例患者（62.8%）被归类为预后不良（GOS 评分 1-3）。血清葡萄糖/钾比值呈出院时 GOS 评分依赖性升高（Spearman r=0.4006，p<0.0001），且在预后不良组中明显高于预后良好组（GOS 评分 4 或 5；p=0.0245）。预后不良与血清葡萄糖/钾比值（p<0.0001）、年龄（p<0.0001）、脑利钠肽水平（p=0.011）、血管痉挛性脑梗死（p<0.0001）和 H-K 分级（p<0.0001）之间存在显著相关性。多变量逻辑回归分析显示，预后不良与血清葡萄糖/钾比值（p=0.009）显著相关。
本研究中，入院时动脉瘤性 SAH 患者的血清葡萄糖/钾比值与 H-K 分级和出院时 GOS 评分显著相关。因此，该比值可用于预测动脉瘤性 SAH 的预后，尤其是在严重情况下。
