Xie Bingsen, Lin Yuanxiang, Wu Xiyue, Yu Lianghong, Zheng Shufa, Kang Dezhi
Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
World Neurosurg. 2020 Apr;136:e24-e32. doi: 10.1016/j.wneu.2019.08.155. Epub 2019 Aug 30.
To retrospectively analyze the relationship between fibrinogen levels and outcomes in poor-grade aneurysmal subarachnoid hemorrhage (aSAH).
We recruited 66 patients with poor-grade aSAH who were treated by neurosurgical clipping between January 2010 and December 2015. Serum samples were taken immediately on admission. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between fibrinogen levels and clinical outcomes.
Nineteen men and 47 women were included; the average age was 57.2 years. The median of the admission serum fibrinogen level was 3.3 g/L. Of the 66 patients, 18 had died by 6 months after initial hemorrhage, whereas 48 patients survived. Multivariate analyses showed that Hunt and Hess grade V (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.06-14.20; P = 0.04) and admission serum fibrinogen level <2.5 g/L (OR, 6.15; 95% CI, 1.67-22.67; P = 0.006) were significantly associated with 6-month mortality. In addition, admission serum fibrinogen level was negatively correlated with delayed cerebral ischemia, and admission serum fibrinogen level <2.5 g/L (OR, 3.86; 95% CI, 0.99-15.09; P = 0.05) was also significantly associated with delayed cerebral ischemia.
Patients with poor-grade aSAH with reduced admission fibrinogen level have a higher risk of delayed cerebral ischemia and 6-month mortality compared with those without. The admission serum fibrinogen level might be useful as a predictor and treatment target in patients with poor-grade sSAH who have undergone surgical treatment.
回顾性分析低级别动脉瘤性蛛网膜下腔出血（aSAH）患者纤维蛋白原水平与预后的关系。
我们纳入了2010年1月至2015年12月期间接受神经外科夹闭治疗的66例低级别aSAH患者。入院时立即采集血清样本。记录基线信息、并发症及6个月时的预后情况。采用单因素和多因素logistic回归分析来探讨纤维蛋白原水平与临床预后的关系。
纳入19例男性和47例女性；平均年龄为57.2岁。入院时血清纤维蛋白原水平的中位数为3.3 g/L。66例患者中，18例在初次出血后6个月内死亡，48例存活。多因素分析显示，Hunt和Hess分级为V级（比值比[OR]，3.89；95%置信区间[CI]，1.06 - 14.20；P = 0.04）及入院时血清纤维蛋白原水平<2.5 g/L（OR，6.15；95% CI，1.67 - 22.67；P = 0.006）与6个月死亡率显著相关。此外，入院时血清纤维蛋白原水平与迟发性脑缺血呈负相关，且入院时血清纤维蛋白原水平<2.5 g/L（OR，3.86；95% CI，0.99 - 15.09；P = 0.05）也与迟发性脑缺血显著相关。
与纤维蛋白原水平未降低的患者相比，入院时纤维蛋白原水平降低的低级别aSAH患者发生迟发性脑缺血和6个月死亡率的风险更高。入院时血清纤维蛋白原水平可能有助于预测接受手术治疗的低级别sSAH患者的预后并作为治疗靶点。
