Shin Kyung Won, Choi Seungeun, Oh Hyongmin, Hwang So Yeong, Park Hee-Pyoung
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, Korea.
J Neurosurg Anesthesiol. 2024 Apr 1;36(2):142-149. doi: 10.1097/ANA.0000000000000906. Epub 2023 Feb 13.
Inflammation is associated with unfavorable clinical outcomes after aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the relationship between postoperative neutrophil-to-albumin ratio (NAR) and unfavorable clinical outcomes (modified Rankin score ≥ 3) at hospital discharge in aSAH patients.
Five hundred sixty aSAH patients undergoing surgical or endovascular treatment were included in this retrospective study. Patients were initially allocated to high (n=247) or low (n=313) postoperative NAR groups based on the immediate postoperative NAR cutoff value identified by receiver operating characteristic analysis, and then further subclassified into 4 groups: HH (high pre- and high postoperative NAR, n=156), LH (low preoperative and high postoperative NAR, n=91), HL (high preoperative and low postoperative NAR, n=68), and low pre- and low postoperative NAR (n=245).
Optimum cutoff values of immediate postoperative and preoperative NAR were 2.45 and 2.09, respectively. Unfavorable clinical outcomes were more frequent in patients with high compared with low postoperative NAR (45.3% vs. 13.4%; P < 0.001). In multivariate analysis, postoperative NAR was a significant predictor of unfavorable clinical outcomes (odds ratio, 2.10; 95% CI, 1.42-3.10; P < 0.001). Unfavorable clinical outcomes were less frequent in group low pre- and low postoperative NAR than in groups HH, LH, and HL (9.4% vs. 44.9%, 46.2% and 27.9%, respectively; all P < 0.001) and also in Group HL compared with groups HH and LH ( P =0.026 and P =0.030); clinical outcomes did not differ between Groups HH and LH.
A high immediate postoperative NAR was associated with unfavorable clinical outcomes at hospital discharge in aSAH patients.
炎症与动脉瘤性蛛网膜下腔出血（aSAH）后的不良临床结局相关。我们评估了aSAH患者术后中性粒细胞与白蛋白比值（NAR）与出院时不良临床结局（改良Rankin评分≥3）之间的关系。
本回顾性研究纳入了560例行手术或血管内治疗的aSAH患者。根据接受者操作特征分析确定的术后即刻NAR临界值，患者最初被分为术后高NAR组（n = 247）或低NAR组（n = 313），然后进一步细分为4组：HH（术前和术后NAR均高，n = 156）、LH（术前NAR低且术后NAR高，n = 91）、HL（术前NAR高且术后NAR低，n = 68）以及术前和术后NAR均低（n = 245）。
术后即刻和术前NAR的最佳临界值分别为2.45和2.09。术后NAR高的患者不良临床结局比低NAR患者更常见（45.3%对13.4%；P < 0.001）。在多变量分析中，术后NAR是不良临床结局的显著预测因素（比值比，2.10；95%可信区间，1.42 - 3.10；P < 0.001）。术前和术后NAR均低的组不良临床结局比HH、LH和HL组更少（分别为9.4%对44.9%、46.2%和27.9%；所有P < 0.001），HL组与HH组和LH组相比也更少（P = 0.026和P = 0.030）；HH组和LH组之间的临床结局无差异。
aSAH患者术后即刻NAR高与出院时不良临床结局相关。
