动脉瘤性蛛网膜下腔出血患者发生急性脑积水的危险因素分析

doi:10.13481/j.1671-587X.20250321

Abstract

Abstract:

Objective To explore the risk factors associated with aneurysmal subarachnoid haemorrhage （aSAH） complicated with acute hydrocephalus （aHCP）， and to provide the clinical reference for the early identification and intervention of these patients. Methods The clinical data and laboratory indexes of 175 patients with aSAH were retrospectively analysed， and the patients were divided into aHCP group （n=56） and non-aHCP group （n=119） according to whether they presented with aHCP after the onset of the disease. Univariate analysis and binary logistic regression were applied to identify the risk factors for the aHCP in aSAH patients， and receiver operating characteristic （ROC） curve analysis with area under the curve （AUC） was used to evaluate the predictive value of these factors. Results A total of 56 （32.0%） out of 175 aSAH patients included developed aHCP after the onset of the disease. Compared with non-aHCP group，the levels of neutrophil count， blood glucose， neutrophil-albumin ratio （NAR）， platelet-lymphocyte ratio （PLR）， neutrophil-lymphocyte ratio （NLR）， monocyte-lymphocyte ratio （MLR）， systemic immune-inflammatory index （SII）， systemic inflammatory response index （SIRI）， and systemic inflammation composite index （AISI） of the patients in aHCP group were significantly increased（P<0.05）， the level of lymphocyte count was significantly decreased （P<0.05）， the Hunt-Hess grade and modified Fisher grade were higher （P<0.05）， and the incidence of ventricular haematochezia was more high （P<0.05）. The binary Logistic regression analysis results showed that the elevated levels of NAR （OR=2.237， 95%CI： 1.063-4.708， P=0.034） and NLR （OR=1.210， 95%CI： 1.095-1.337， P<0.01） were the independent risk factors for the development of aHCP after aSAH. The ROC curve analysis showed that the AUC of NAR was 0.812 （95%CI： 0.745-0.878， P<0.001）， the AUC of NLR was 0.844 （95%CI： 0.785-0.903， P<0.001）， and the combined AUC of NAR and NLR was 0.854 （95%CI： 0.798-0.910， P<0.001）. Conclusion NAR and NLR are independent risk factors for the development of aHCP in aSAH patients.

Key words: Aneurysmal subarachnoid hemorrhage, Acute hydrocephalus, Neuroinflammatory response, Risk factor

CLC Number:

R651.1

Jiahui FENG,Renjie LIU,Xuan CHEN. Analysis on risk factors of development of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage[J].Journal of Jilin University(Medicine Edition), 2025, 51(3): 763-769.

Figures/Tables 5

Tab.1

General informations of patients in aHCP group and non-aHCP group"

Clinical data	aHCP group （n=56）	Non-aHCP group （n=119)	t /Z/χ²	P
Age（year）	60.361±8.814	59.131±10.097	-0.783	-0.435
Female（n/%）	34（60.7）	86（72.3）	2.469	-0.116
Hypertension（n/%）	31（55.4）	57（47.5）	0.943	-0.332
Location of aneurysm（n/%）			4.465	-0.347
ACoA	12（21.4）	41（34.5）
PCoA	20（35.7）	33（27.7）
ACA	6（10.7）	9（7.6）
MCA	12（21.4）	24（20.2）
Posterior circulation aneurysm	6（10.7）	12（10.1）
Intraventricular hemorrhage （n/%）	33（58.9）	43（36.1）	8.301	-0.004
Hunt-Hess grade （n/%）			25.701	<0.001
Ⅰ/Ⅱ	37（66.1）	96（80.7）
Ⅲ/Ⅳ	19 （33.9）	23（19.3）
Modified Fisher grade （n/%）			26.682	<0.001
Ⅰ/Ⅱ	36（64.3）	93（78.2）
Ⅲ/Ⅳ	20（35.7）	26（21.8）
Laboratory testing
RDW [n/%, M （P25, P75）]	12.55（12.30,13.18）	12.60（12.20,13.20）	-0.114	0.909
NE#（×10⁹ L^-1， x±s）	12.63±3.56	8.60±2.96	-7.864	<0.001
LY#（×10⁹ L^-1， x±s）	0.81（0.66,1.01）	1.10（0.88,1.67）	-4.973	<0.001
MO#（×10⁹ L^-1， x±s）	0.51±0.29	0.47±0.23	-1.075	0.284
FBG [g?L^-1, x±s]	2.91±0.73	2.81±0.69	-0.872	0.385
Albumin [ρ_B/（g?L^-1）, x±s]	42.79±3.52	42.35±3.21	-0.817	0.471
Serum sodium [mmol?L^-1, M （P25, P75）]	137.00（135.90,139.50）	137.75（136.33,140.03）	-1.223	0.221
Blood glucose [mmol?L^-1, M （P25, P75）]	7.52（6.29,9.20）	6.66（5.79,8.18）	-2.5	0.012
NAR （x±s）	0.295±0.081	0.202±0.068	-7.956	<0.001
PLR [M （P25, P75）]	281.13（225.88,387.02）	187.40（127.03,252.05）	-5.574	<0.001
NLR [M （P25, P75）]	15.73（11.57,20.17）	7.80（4.07,11.96）	-7.330	<0.001
MLR [M （P25, P75）]	0.60（0.37,0.76）	0.36（0.26,0.49）	-4.731	<0.001
FAR [M （P25, P75）]	0.067（0.057,0.078）	0.061（0.054,0.076）	-0.704	0.482
SII [M （P25, P75）]	3 557.22（2 449.00,5 016.03）	1 656.14（864.80,2 458.38）	-7.272	<0.001
SIRI [M （P25, P75）]	6.66（3.88,10.25）	2.87（1.76,4.80）	-6.229	<0.001
AISI [M （P25, P75）]	1 605.69（878.82,2 398.48）	637.84（364.09,1 034.62）	-6.140	<0.001

Tab.1

Tab. 2

Tab. 3

Fig. 1

Tab.4

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Factor	Assignment method
Dependent variable	Non-aHCP group=0； aHCP group=1
Independent variables
Intraventricular hemorrhage	NO=0, YES=1
Hunt-Hess grade	Ⅰ/Ⅱ=0, Ⅲ/Ⅳ=1
Modified Fisher grade	Ⅰ/Ⅱ=0, Ⅲ/Ⅳ=1
NE# LY#	Continuous variable Continuous variable
Blood glucose NAR PLR NLR MLR	Continuous variable Continuous variable Continuous variable Continuous variable Continuous variable
SII SIRI AISI	Continuous variable Continuous variable Continuous variable

Variable	b	SE	Wald χ²	OR （95%CI）	P
Intraventricular hemorrhage	0.384	0.481	0.638	1.468(0.572-3.765)	0.425
Hunt-Hess grade	1.160	0.635	3.339	3.191(0.919-11.079)	0.068
Modified Fisher grade	0.445	0.545	0.667	1.561(0.536-4.546)	0.414
NE#	0.133	0.366	0.131	1.142(0.558-2.338)	0.717
LY#	0.277	0.890	0.097	1.319(0.231-7.550)	0.755
Blood glucose	0.076	0.106	0.529	1.079(0.875-1.332)	0.477
NAR	0.805	0.380	4.502	2.237（1.063-4.708)	0.034
PLR	0.009	0.008	1.356	1.009 (0.997-1.031)	0.244
NLR	0.190	0.051	13.931	1.210（1.095-1.337)	<0.001
MLR	1.175	0.835	2.050	3.238(0.630-16.638)	0.159
SII	0.000	0.001	0.217	1.000(0.998-1.003)	0.641
SIRI	-0.236	0.502	0.220	0.790(0.295-2.114)	0.790
AISI	0.001	0.002	0.097	1.001(0.997-1.005)	0.725

Variable	Cut-off value	Sensitivity	Specificity	AUC（95%CI）	P
NAR	0.249	0.696	0.790	0.812（0.745，0.878）	<0.001
NLR	9.901	0.929	0.613	0.844（0.785，0.903）	<0.001
NAR combined with NLR	-	0.929	0.664	0.854（0.798，0.910）	<0.001

Analysis on risk factors of development of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage

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