Wang Haojie, Zheng Shufa, Zhang Yibin, Fan Wenjian, Xie Bingsen, Chen Fuxiang, Lin Yuanxiang, Kang Dezhi
Department of Neurosurgery, Neurosurgical Research Institute, First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
Brain Sci. 2023 Aug 23;13(9):1232. doi: 10.3390/brainsci13091232.
Iron plays an important role in neuronal injury and edema formation after intracranial hemorrhage. However, the role of serum iron in aneurysmal subarachnoid hemorrhage (aSAH) is yet to be well-established. This study aims to identify whether serum iron could predict postoperative global cerebral edema (GCE) and poor outcome in aSAH.
847 patients' aSAH clinical data were retrospectively collected at the First Affiliated Hospital of Fujian Medical University. Data on demographics, clinical characteristics, and laboratory values were collected and analyzed through univariate and multivariate analyses. Propensity score matching (PSM) analysis was performed to balance the baseline differences between the groups.
The incidence of high-grade global cerebral edema (H-GCE) following aSAH was 12.99% (110/847). Serum iron levels [odds ratio (OR) = 1.143; 95% confidence interval (CI), (1.097-1.191); < 0.001] were associated with the occurrence of H-GCE following aSAH in the univariate analysis. This association remained statistically significant even after adjusting for other variables in the multivariate model, with serum iron having an OR of 1.091 (95% CI, 1.043-1.141; < 0.001) for GCE. After 1:1 PSM, serum iron levels ≤ 10.7 µmol/L remained a significant independent predictor of GCE ( = 0.002). The receiver operating characteristic (ROC) curve analysis determined that a serum iron cut-off value of ≤ 10.7 µmol/L was optimal for predicting H-GCE [Areas under the ROC curves (AUC) = 0.701, 95% CI, (0.669-0.732), < 0.001; sensitivity, 67.27%; specificity, 63.77%] in patients with aSAH. Additionally, a trend was observed in which higher Hunt-Hess grades (HH grade) were associated with lower serum iron levels, and higher modified Fisher grades (mFisher grade) were associated with lower serum iron levels. In addition, the serum iron level was also associated with a 3-month functional neurological outcome ( < 0.001).
The results of this study indicate that a decreased serum iron level serves as a clinically significant biomarker for the prediction of postoperative GCE and a poor outcome at 3-months in patients with aSAH.
铁在颅内出血后的神经元损伤和水肿形成中起重要作用。然而，血清铁在动脉瘤性蛛网膜下腔出血（aSAH）中的作用尚未完全明确。本研究旨在确定血清铁是否可预测aSAH患者术后的全脑水肿（GCE）及不良预后。
回顾性收集福建医科大学附属第一医院847例aSAH患者的临床资料。收集人口统计学、临床特征和实验室检查值等数据，并通过单因素和多因素分析进行分析。采用倾向评分匹配（PSM）分析平衡组间基线差异。
aSAH后重度全脑水肿（H-GCE）的发生率为12.99%（110/847）。单因素分析显示，血清铁水平[比值比（OR）=1.143；95%置信区间（CI），（1.097-1.191）；P<0.001]与aSAH后H-GCE的发生相关。在多因素模型中调整其他变量后，这种相关性仍具有统计学意义，血清铁对GCE的OR为1.091（95%CI，1.043-1.141；P<0.001）。经过1:1的PSM分析后，血清铁水平≤10.7µmol/L仍然是GCE的显著独立预测因素（P=0.002）。受试者工作特征（ROC）曲线分析确定，血清铁截断值≤10.7µmol/L对预测aSAH患者的H-GCE最为理想[ROC曲线下面积（AUC）=0.701，95%CI，（0.669-0.732），P<0.001；敏感性为67.27%；特异性为63.77%]。此外，观察到一种趋势，即Hunt-Hess分级（HH分级）越高，血清铁水平越低，改良Fisher分级（mFisher分级）越高，血清铁水平越低。此外，血清铁水平还与3个月时的功能性神经学预后相关（P<0.001）。
本研究结果表明，血清铁水平降低是预测aSAH患者术后GCE及3个月时不良预后的具有临床意义的生物标志物。
