Zhang Dingding, Zhuang Zong, Wei Yongxiang, Liu Xiangyu, Li Wei, Gao Yongyue, Li Jinsong, Hang Chunhua
Department of Neurosurgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, P.R. China.
Department of Neurosurgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, P.R. China.
World Neurosurg. 2019 Jul;127:e1145-e1151. doi: 10.1016/j.wneu.2019.04.071. Epub 2019 Apr 14.
Serum hyperglycemia and hypophosphatemia have been reported to be common in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to explore whether admission serum glucose-phosphate ratio was associated with the severity and prognosis of aSAH.
We retrospectively analyzed 198 patients with aSAH who were admitted within 24 hours of hemorrhage to a single academic hospital from June 2016 to September 2017. The following determinations were recorded: aSAH severity on admission, assessment by the World Federation of Neurosurgical Societies grading scale (WFNS), Fisher score defined according to the computed tomography results, and 3-month outcome assessed by the Glasgow Outcome Scale. A statistical analysis of the clinical and laboratory risk factors of poor outcome was conducted.
Admission serum glucose-phosphate ratio was increased in a WFNS grade-dependent manner and was higher in patients who had a poor outcome than in those who had a good outcome 3 months after aSAH. Multiple binomial logistic regression analysis showed that serum glucose-phosphate ratio, along with age, WFNS grade, and intraventricular hemorrhage, was associated with 3-month poor outcome after aSAH when we controlled for Fisher score, acute hydrocephalus, delayed cerebral ischemia, symptomatic cerebral vasospasm, serum glucose and phosphate levels, and glucose-potassium ratio. Receiver operating characteristic analysis showed that the area under the curve for glucose-phosphate ratio was significantly higher than age and intraventricular hemorrhage.
The study shows that the glucose-phosphate ratio is a potential biomarker that can reflect disease severity and prognosis in aSAH patients.
据报道，动脉瘤性蛛网膜下腔出血（aSAH）患者中血清高血糖和低磷血症较为常见。本研究旨在探讨入院时血清葡萄糖 - 磷酸盐比值是否与aSAH的严重程度及预后相关。
我们回顾性分析了2016年6月至2017年9月期间在一家学术医院出血后24小时内入院的198例aSAH患者。记录了以下指标：入院时aSAH的严重程度，采用世界神经外科协会联合会分级量表（WFNS）进行评估，根据计算机断层扫描结果定义的Fisher评分，以及采用格拉斯哥预后量表评估的3个月结局。对不良结局的临床和实验室危险因素进行了统计分析。
入院时血清葡萄糖 - 磷酸盐比值以WFNS分级依赖的方式升高，aSAH后3个月结局不良的患者该比值高于结局良好的患者。多项二项式逻辑回归分析显示，当我们控制Fisher评分、急性脑积水、迟发性脑缺血、症状性脑血管痉挛、血清葡萄糖和磷酸盐水平以及葡萄糖 - 钾比值时，血清葡萄糖 - 磷酸盐比值以及年龄、WFNS分级和脑室内出血与aSAH后3个月的不良结局相关。受试者工作特征分析表明，葡萄糖 - 磷酸盐比值的曲线下面积显著高于年龄和脑室内出血。
该研究表明，葡萄糖 - 磷酸盐比值是一种潜在的生物标志物，可反映aSAH患者的疾病严重程度和预后。
