Low serum albumin as a risk factor for delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage: eICU collaborative research database analysis.
Alis J Dicpinigaitis, Vincent P Galea, Tolga Sursal, Hussein Al-Shammari, Eric Feldstein, Syed Ali, Serena Wong, Christian Bowers, Christian Becker, Jared Pisapia, Carrie Muh, Simon Hanft, Rachana Tyagi, Stephan A Mayer, Chirag D Gandhi, Fawaz Al-Mufti
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引用次数: 0
Abstract
Background: Delayed cerebral ischemia (DCI) represents a devastating complication of aneurysmal subarachnoid hemorrhage (aSAH) and is a significant predictor of morbidity and mortality. Recent studies have implicated inflammatory processes in the pathogenesis of DCI.
Methods: aSAH patient data were retrospectively obtained from the eICU Collaborative Research Database (eICU CRD). Multivariable logistic regression models and receiver operating characteristic (ROC) curve analyses were employed to assess the association between low serum albumin (<3.4 g/dL) and clinical endpoints: DCI and in-hospital mortality.
Results: Among 276 aSAH patients included in the analysis, 35.5% (N.=98) presented with low serum albumin levels and demonstrated a higher incidence of DCI (18.4% vs. 8.4%, OR=2.45, 95% CI=1.17, 5.10; P=0.017) and in-hospital mortality (27.6% vs. 16.3%, OR=1.95, 95% CI=1.08, 3.54; P=0.027) compared to patients with normal admission albumin values. In a multivariable model controlling for age and World Federation of Neurosurgical Societies grade, low serum albumin remained significantly associated with DCI (OR=2.52, 95% CI=1.18, 5.36; P=0.017), but not with in-hospital mortality. A combined model for prediction of DCI, encompassing known risk factors in addition to low serum albumin, achieved an area under the curve of 0.65 (sensitivity = 0.55, specificity = 0.75).
Conclusions: Serum albumin, a routine and inexpensive laboratory measurement, may potentially aid in the identification of patients with aSAH at risk for the development of DCI.
背景:延迟性脑缺血(DCI)是动脉瘤性蛛网膜下腔出血(aSAH)的一种破坏性并发症,是发病率和死亡率的重要预测因素。最近的研究表明,炎症过程与 DCI 的发病机制有关。方法:从 eICU 协作研究数据库(eICU CRD)中回顾性获得了 aSAH 患者的数据。采用多变量逻辑回归模型和接收器操作特征曲线(ROC)分析来评估低血清白蛋白(< 3.4 g/dL)与临床终点之间的关系:结果:在纳入分析的276例aSAH患者中,35.5%(n=98)的患者血清白蛋白水平较低,与入院白蛋白值正常的患者相比,DCI(18.4% vs. 8.4%,OR=2.45,95% CI 1.17,5.10;p=0.017)和院内死亡率(27.6% vs. 16.3%,OR=1.95,95% CI 1.08,3.54;p=0.027)发生率较高。在控制年龄和世界神经外科学会联合会等级的多变量模型中,低血清白蛋白仍与 DCI 显著相关(OR=2.52,95% CI 1.18,5.36;p=0.017),但与院内死亡率无关。除了低血清白蛋白外,还包括已知风险因素的DCI综合预测模型的曲线下面积为0.65(灵敏度=0.55,特异性=0.75):血清白蛋白是一种常规且廉价的实验室测量指标,可能有助于识别有发生 DCI 风险的SAH 患者。
期刊介绍:
The Journal of Neurosurgical Sciences publishes scientific papers on neurosurgery and related subjects (electroencephalography, neurophysiology, neurochemistry, neuropathology, stereotaxy, neuroanatomy, neuroradiology, etc.). Manuscripts may be submitted in the form of ditorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.