Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Center for Evidence Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Ann Clin Transl Neurol. 2022 Oct;9(10):1565-1573. doi: 10.1002/acn3.51650. Epub 2022 Aug 19.
Lactate dehydrogenase (LDH) has been reported to be associated with outcomes after surgery in patients with aneurysmal subarachnoid hemorrhage (aSAH), but it is unclear if this is independent from other biomarkers and across all aSAH treatments. This study aims to assess whether LDH is an independent predictor of mortality in patients with aSAH and test whether the inclusion of LDH in a well-established prediction model can improve discrimination and reclassification.
This was a retrospective observational study at a tertiary academic medical center. This study measured baseline LDH levels taken at admission and longitudinal LDH levels (up to a month postadmission) to assess median, max, and trajectory LDH levels. The primary outcome was mortality at 90 days. Multivariable regression analyses were used to evaluate associations between LDH and outcomes. The full original Subarachnoid Hemorrhage International Trialists' (SAHIT) model was used as the reference model.
In total, 3524 patients with aSAH were included. LDH at admission was independently associated with mortality at 90 days (quartile 4 vs. 1: odds ratio 1.60; 95% CI 1.08-2.37) and mortality at the longest follow-up (quartile 4 vs. 1: hazard ratio1.72; 95% CI 1.34-2.20). Compared with the SAHIT model, the addition of three LDH (admission, max, and median) levels to the SAHIT model significantly improved the area under the curve and categorical net reclassification improvement for prediction mortality.
In patients with aSAH, LDH level is an independent predictor of all-cause mortality. The incorporation of LDH into a well-established prediction model improved the ability to predict the risk of death in patients with aSAH.
乳酸脱氢酶（LDH）已被报道与蛛网膜下腔出血（aSAH）患者手术后的结局相关，但尚不清楚其是否独立于其他生物标志物，以及是否适用于所有 aSAH 治疗。本研究旨在评估 LDH 是否是 aSAH 患者死亡的独立预测因子，并检验将 LDH 纳入经过验证的预测模型是否可以提高区分度和重新分类能力。
这是一项在三级学术医疗中心进行的回顾性观察性研究。本研究测量了入院时的基线 LDH 水平和（入院后）一个月内的 LDH 水平，以评估中位数、最大值和 LDH 水平轨迹。主要结局是 90 天的死亡率。采用多变量回归分析评估 LDH 与结局之间的关系。采用完整的原始蛛网膜下腔出血国际试验者（SAHIT）模型作为参考模型。
共纳入 3524 例 aSAH 患者。入院时的 LDH 与 90 天死亡率（第 4 四分位数与第 1 四分位数：比值比 1.60；95%置信区间 1.08-2.37）和最长随访时间的死亡率（第 4 四分位数与第 1 四分位数：风险比 1.72；95%置信区间 1.34-2.20）独立相关。与 SAHIT 模型相比，将 LDH （入院、最大值和中位数）三个水平添加到 SAHIT 模型中显著提高了预测死亡率的曲线下面积和分类净重新分类改善。
在 aSAH 患者中，LDH 水平是全因死亡率的独立预测因子。将 LDH 纳入经过验证的预测模型可以提高预测 aSAH 患者死亡风险的能力。
