Department of Neurosurgery, Dehua County Hospital, Quanzhou, China.
Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
World Neurosurg. 2019 Jun;126:e907-e913. doi: 10.1016/j.wneu.2019.03.009. Epub 2019 Mar 11.
We tested the hypothesis that low serum iron levels are associated with acute hydrocephalus following aneurysmal subarachnoid hemorrhage (aSAH).
Patients presenting with ruptured intracranial aneurysms were enrolled in the prospective observational study. Age, sex, history of diabetes, hypertension and hyperlipidemia, symptom onset, Fisher grade, Hunt-Hess grade, aneurysm location, hemoglobin, and serum iron were collected. Acute hydrocephalus was determined within 72 hours after subarachnoid hemorrhage. A propensity-score matching analysis was performed to correct imbalances in patient characteristics between hydrocephalus and non-hydrocephalus groups.
A total of 535 patients were included. Incidence of acute hydrocephalus was 20.0%. In multivariate logistic regression analysis, lower serum iron was considered as a risk factor of acute hydrocephalus, as well as delayed ischemic neurologic deficit and lower hemoglobin (P = 0.000). After propensity-score matching, lower serum iron was considered as an independent risk factor for acute hydrocephalus, whereas hemoglobin and delayed ischemic neurologic deficit were not. The matched hydrocephalus group had lower serum iron comparing with the matched non-hydrocephalus group (10.26 ± 5.33 mmol/L vs. 13.44 ± 5.18 mmol/L; P = 0.000). The optimal cut-off value for serum iron levels as a predictor for acute hydrocephalus in patients with aSAH was determined as 13.1 mmol/L in the receiver operating characteristic curve. Furthermore, lower serum iron levels (odds ratio 0.305; 95% confidence interval, 0.178-0.524; P = 0.000) and acute hydrocephalus (odds ratio 0.372; 95% confidence interval, 0.202-0.684; P = 0.001) were predictors of poor outcome, as well as higher Hunt-Hess grade and Fisher grade.
Lower serum iron levels after aSAH was a predictor of acute hydrocephalus and unfavorable outcome.
我们检验了低血清铁水平与动脉瘤性蛛网膜下腔出血（aSAH）后急性脑积水相关的假说。
本前瞻性观察性研究纳入了表现为颅内破裂动脉瘤的患者。收集患者的年龄、性别、糖尿病、高血压和高血脂病史、发病症状、Fisher 分级、Hunt-Hess 分级、动脉瘤位置、血红蛋白和血清铁水平。在蛛网膜下腔出血后 72 小时内确定急性脑积水。通过倾向评分匹配分析来校正脑积水组和非脑积水组之间患者特征的不平衡。
共纳入 535 例患者，急性脑积水的发生率为 20.0%。在多变量逻辑回归分析中，较低的血清铁被认为是急性脑积水的危险因素，此外还有迟发性缺血性神经功能缺损和较低的血红蛋白（P=0.000）。经过倾向评分匹配后，较低的血清铁被认为是急性脑积水的独立危险因素，而血红蛋白和迟发性缺血性神经功能缺损则不是。匹配后的脑积水组血清铁水平明显低于匹配后的非脑积水组（10.26±5.33mmol/L 比 13.44±5.18mmol/L；P=0.000）。受试者工作特征曲线确定血清铁水平作为预测 aSAH 患者急性脑积水的最佳截断值为 13.1mmol/L。此外，较低的血清铁水平（比值比 0.305；95%置信区间，0.178-0.524；P=0.000）和急性脑积水（比值比 0.372；95%置信区间，0.202-0.684；P=0.001）以及较高的 Hunt-Hess 分级和 Fisher 分级都是不良结局的预测因素。
aSAH 后较低的血清铁水平是急性脑积水和不良结局的预测因素。
