Wu Wei, Liu Xunzhi, Zhu Qi, Chen Xiangxin, Sheng Bin, Zhang Jiatong, Li Wei, Zhang Dingding, Hang Chunhua
Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Xuzhou 221004, China.
Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Brain Sci. 2022 Dec 12;12(12):1700. doi: 10.3390/brainsci12121700.
: Aneurysmal subarachnoid hemorrhage (aSAH) is a severe neurological event with limited treatment options, and little is known about its pathophysiology. There are few objective tools for predicting outcomes of aSAH patients and further aiding in directing clinical therapeutic programs. This study aimed to determine whether an elevated serum D-dimer/albumin ratio (DAR) reflects disease severity and predicts aSAH outcomes. : We included 178 patients with aSAH. Data included demographics; clinical severity of aSAH (World Federation of Neurological Societies (WFNS) grade and Hunt-Hess grade); levels of D-dimer, albumin, and c-reactive protein (CRP); leukocyte counts on admission; and three-month outcomes. The outcomes were dichotomized into good and poor. The predictive ability of DAR for outcomes was determined using receiver operating characteristic (ROC) curve analysis. : Serum DAR showed a positive correlation with disease severity. Univariate analysis revealed that DAR, WFNS grade, Hunt-Hess grade, delayed cerebral infarction (DCI), age, neutrophil-to-lymphocyte ratio (NLR), and CRP/albumin ratio (CAR) were associated with unfavorable outcomes. Multivariate regression analysis further revealed that elevated DAR predicted poor outcomes after adjusting for WFNS grade, Hunt-Hess grade, DCI, age, NLR, and CRP/albumin ratio. Receiver operating characteristic curve analysis revealed that DAR predicted outcomes at a level comparable with NLR and CAR and had superior predictivity than D-dimer alone. : DAR is a promising objective tool for aSAH outcome prediction. A high content DAR was associated with disease severity and unfavorable short-term outcomes.
动脉瘤性蛛网膜下腔出血（aSAH）是一种严重的神经事件，治疗选择有限，其病理生理学也鲜为人知。用于预测aSAH患者预后并进一步辅助指导临床治疗方案的客观工具很少。本研究旨在确定血清D-二聚体/白蛋白比值（DAR）升高是否反映疾病严重程度并预测aSAH的预后。
我们纳入了178例aSAH患者。数据包括人口统计学信息；aSAH的临床严重程度（世界神经外科联盟（WFNS）分级和Hunt-Hess分级）；D-二聚体、白蛋白和C反应蛋白（CRP）水平；入院时白细胞计数；以及三个月的预后情况。将预后分为良好和不良两类。使用受试者工作特征（ROC）曲线分析来确定DAR对预后的预测能力。
血清DAR与疾病严重程度呈正相关。单因素分析显示，DAR、WFNS分级、Hunt-Hess分级、迟发性脑梗死（DCI）、年龄、中性粒细胞与淋巴细胞比值（NLR）以及CRP/白蛋白比值（CAR）与不良预后相关。多因素回归分析进一步显示，在调整了WFNS分级、Hunt-Hess分级、DCI、年龄、NLR和CRP/白蛋白比值后，DAR升高可预测不良预后。ROC曲线分析显示，DAR预测预后的水平与NLR和CAR相当，且预测性优于单独的D-二聚体。
DAR是一种有前景的用于预测aSAH预后的客观工具。高含量的DAR与疾病严重程度和不良短期预后相关。
