Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Anhui Public Health Clinical Center, Hefei, China.
Neurol Sci. 2024 Jan;45(1):213-222. doi: 10.1007/s10072-023-07014-1. Epub 2023 Aug 14.
To investigate the impact of human serum albumin (HSA) levels on symptomatic cerebral vasospasm (SCVS) in patients with aneurysmal subarachnoid hemorrhage (aSAH).
We retrospectively reviewed the medical records. SCVS was defined as the development of a new neurological deterioration when the cause was considered to be ischemia attributable to vasospasm after other possible causes of worsening had been excluded. The aSAH patients were divided into two groups: those with SCVS (group 1) and those without SCVS (group 2). The HSA level data on the 1st, 2nd, and 3rd day after admission was collected. Multivariate logistical regression and receiver operating characteristic (ROC) analysis were performed to evaluate the ability of HSA level to predict the development of SCVS.
A total of 270 patients were included in our study, of which 74 (27.4%) developed SCVS. The average and lowest HSA levels were lower in group 1 (P < 0.001). In univariate logistic regression, white blood cell count, neutrophil count, and average and lowest HSA levels were associated with SCVS. After adjustment for age, CT Fisher grade, Hunt-Hess grade, and WFNS grade, both the average and lowest HSA levels remained independent predictors of SCVS (P < 0.001). The CT Fisher grade was confirmed to be an independent predictor of SCVS across each model. ROC analysis revealed that the lowest HSA level was a better predictor for SCVS than average HSA level and CT Fisher grade.
Clinicians are encouraged to measure HSA levels for the first 3 days after admission to predict the occurrence of SCVS after aSAH.
探讨人血清白蛋白（HSA）水平对伴有蛛网膜下腔出血（aSAH）的症状性脑血管痉挛（SCVS）的影响。
我们回顾性地审查了病历。SCVS 的定义为在排除其他可能导致恶化的原因后，认为新出现的神经功能恶化是由血管痉挛引起的缺血所致。将 aSAH 患者分为两组：发生 SCVS 的患者（第 1 组）和未发生 SCVS 的患者（第 2 组）。收集入院第 1、2、3 天的 HSA 水平数据。采用多变量逻辑回归和受试者工作特征（ROC）分析来评估 HSA 水平预测 SCVS 发生的能力。
共有 270 例患者纳入研究，其中 74 例（27.4%）发生 SCVS。第 1 组的平均 HSA 水平和最低 HSA 水平均较低（P<0.001）。在单变量逻辑回归中，白细胞计数、中性粒细胞计数、平均 HSA 水平和最低 HSA 水平与 SCVS 相关。在校正年龄、CT Fisher 分级、Hunt-Hess 分级和 WFNS 分级后，平均 HSA 水平和最低 HSA 水平仍然是 SCVS 的独立预测因素（P<0.001）。CT Fisher 分级被证实是每个模型中 SCVS 的独立预测因素。ROC 分析表明，最低 HSA 水平是预测 SCVS 的更好指标，优于平均 HSA 水平和 CT Fisher 分级。
建议临床医生在入院后前 3 天测量 HSA 水平，以预测 aSAH 后 SCVS 的发生。
