Predictive value of cerebral perfusion pressure monitoring combined with platelet volume index for delayed cerebral ischemia after intracranial aneurysm embolization

doi:10.11817/j.issn.1673-9248.2022.06.004

Abstract

Abstract:

Objective

To investigate the predictive value of cerebral perfusion pressure (CPP) combined with platelet volume index (PVI) for delayed cerebral ischemia (DCI) after embolization of intracranial aneurysms.

Methods

146 patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent intracranial aneurysm embolization at Handan Central Hospital from December 2018 to December 2021 were included for retrospective analysis. The patients divided into 2 groups according to the presence or absence of DCI, the DCI group (32 patients) and the non-DCI group (114 patients). Clinical data of patients were collected, and the relationship and predictive ability of CPP and PVI with DCI after aneurysm embolization were analyzed by univariate analysis and multifactorial logistic regression analysis, aiming to reveal independent risk factors for the development of DCI in the patients and to draw subject characteristic workup (ROC) curves.

Results

The results of univariate analysis showed that the differences were statistically significant when comparing in Hunt-Hess classification, modified Fisher classification, and hypoproteinemia between patients in the DCI group and non-DCI group (P＜0.05), and the PVI index after aneurysm embolization was significantly higher in the DCI group than that in the non-DCI group [(6.03%±2.40%) vs (3.97%±2.10%)]. CPP was lower than that of the non-DCI group [(66.53±17.02) mmHg vs (90.24±23.13) mmHg], with statistically significant differences (t=4.720, 6.394, P＜0.001). Multifactorial logistic regression analysis showed that Hunt-Hess classification, modified Fisher classification, and PVI were risk factors for the occurrence of DCI after aSAH (OR=31.941, 1.156, 1.513, P=0.001, 0.047, 0.016), and CPP was a protective factor (OR=0.909, P＜0.001).The results of ROC curve analysis suggested that the area under the curve (AUC) of PVI, CPP, and PVI+CPP were 0.753, 0.788, and 0.879, respectively; the Jorden index was 0.46, 0.48, and 0.59, respectively; the sensitivity was 90.6%, 87.5%, and 87.5%, respectively; the specificity was 56.1%, 60.5%, and 70.1%; the best cut-off values of PVI and CPP were 3.69% and 82.5 mmHg (1 mmHg=0.133 kPa), respectively.

Conclusion

PVI and CPP are closely related to the occurrence of DCI after aneurysm embolization and can be used as predictors of the occurrence of DCI after surgery.PVI combined with CPP has a high predictive value for predicting the occurrence of DCI after aneurysm embolization.

Key words: Aneurysmal subarachnoid hemorrhage, Delayed cerebral ischemia, Platelet volume index, Cerebral perfusion pressure, Predictive value

Xu Zhu, Cuixia Guo, Jie Wei, Ning Zhang, Xiwang Wang, Guoyuan Yu. Predictive value of cerebral perfusion pressure monitoring combined with platelet volume index for delayed cerebral ischemia after intracranial aneurysm embolization[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(06): 392-397.

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Figures/Tables 4

项目	DCI组（n=32）	非DCI组（n=114）	χ²/t值	P值
年龄（岁， $x ¯$ ±s）	63.65±11.75	66.03±10.96	t=0.875	0.383
男[例（%）]	18（56.25）	68（59.64）	χ²=0.763	0.435
BMI（kg/m²， $x ¯$ ±s）	24.78±4.25	25.38±4.26	t=0.834	0.405
发病至术前时间（h， $x ¯$ ±s）	7.34±4.23	7.81±4.27	t=0.554	0.581
吸烟史[例（%）]	15（46.87）	47（41.22）	χ²=0.101	0.750
饮酒史[例（%）]	16（50）	55（48.24）	χ²=2.561	0.110
基础疾病[例（%）]
高血压	24（75）	86（75.43）	χ²=0.003	0.959
糖尿病	13（40.62）	53（46.49）	χ²=0.347	0.556
冠心病	11（34.37）	29（25.43）	χ²=1.003	0.317
脑卒中病史	6（18.75）	18（15.78）	χ²=0.159	0.690
高脂血症	9（28.12）	24（21.05）	χ²=0.714	0.398
动脉瘤位置[例（%）]			χ²=1.054	0.590
颈内动脉	12（37.50）	35（30.70）
前交通动脉	7（21.87）	21（18.42）
大脑中动脉	13（40.62）	58（50.87）
动脉瘤直径[例（%）]			χ²=0.311	0.856
≤5 mm	20（62.50）	66（57.89）
6~10 mm	9（28.12）	38（33.33）
＞10 mm	3（9.37）	10（8.77）
Hunt-Hess分级[例（%）]			χ²=6.899	0.009
Ⅰ~Ⅱ级	11（34.47）	69（60.52）
Ⅲ~Ⅳ级	21（65.62）	45（39.47）
WFNS评分[例（%）]			χ²=14.508	＜0.001
Ⅰ~Ⅱ级	9（28.12）	75（65.78）
Ⅲ~Ⅳ级	23（71.87）	39（34.21）
改良Fisher分级[例（%）]			χ²=14.687	＜0.001
Ⅰ~Ⅱ级	8（25.00）	72（63.15）
Ⅲ~Ⅳ级	24（75.00）	42（36.84）
低蛋白血症[例（%）]	15（46.87）	24（21.05）	χ²=8.510	0.004
FPG（mmol/L， $x ¯$ ±s）	9.35±3.48	9.61±3.28	t=0.398	0.692
TC（mmol/L， $x ¯$ ±s）	4.49±1.36	4.56±1.19	t=0.277	0.782
TG（mmol/L， $x ¯$ ±s）	1.19±0.49	1.14±0.50	t=0.530	0.597
LDL-C（mmol/L， $x ¯$ ±s）	3.51±1.28	3.67±1.56	t=0.543	0.588
HDL-C（mmol/L， $x ¯$ ±s）	1.30±0.39	1.38±0.44	t=1.039	0.303

项目	DCI组（n=32）	非DCI组（n=114）	χ²/t值	P值
年龄（岁， $x ¯$ ±s）	63.65±11.75	66.03±10.96	t=0.875	0.383
男[例（%）]	18（56.25）	68（59.64）	χ²=0.763	0.435
BMI（kg/m²， $x ¯$ ±s）	24.78±4.25	25.38±4.26	t=0.834	0.405
发病至术前时间（h， $x ¯$ ±s）	7.34±4.23	7.81±4.27	t=0.554	0.581
吸烟史[例（%）]	15（46.87）	47（41.22）	χ²=0.101	0.750
饮酒史[例（%）]	16（50）	55（48.24）	χ²=2.561	0.110
基础疾病[例（%）]
高血压	24（75）	86（75.43）	χ²=0.003	0.959
糖尿病	13（40.62）	53（46.49）	χ²=0.347	0.556
冠心病	11（34.37）	29（25.43）	χ²=1.003	0.317
脑卒中病史	6（18.75）	18（15.78）	χ²=0.159	0.690
高脂血症	9（28.12）	24（21.05）	χ²=0.714	0.398
动脉瘤位置[例（%）]			χ²=1.054	0.590
颈内动脉	12（37.50）	35（30.70）
前交通动脉	7（21.87）	21（18.42）
大脑中动脉	13（40.62）	58（50.87）
动脉瘤直径[例（%）]			χ²=0.311	0.856
≤5 mm	20（62.50）	66（57.89）
6~10 mm	9（28.12）	38（33.33）
＞10 mm	3（9.37）	10（8.77）
Hunt-Hess分级[例（%）]			χ²=6.899	0.009
Ⅰ~Ⅱ级	11（34.47）	69（60.52）
Ⅲ~Ⅳ级	21（65.62）	45（39.47）
WFNS评分[例（%）]			χ²=14.508	＜0.001
Ⅰ~Ⅱ级	9（28.12）	75（65.78）
Ⅲ~Ⅳ级	23（71.87）	39（34.21）
改良Fisher分级[例（%）]			χ²=14.687	＜0.001
Ⅰ~Ⅱ级	8（25.00）	72（63.15）
Ⅲ~Ⅳ级	24（75.00）	42（36.84）
低蛋白血症[例（%）]	15（46.87）	24（21.05）	χ²=8.510	0.004
FPG（mmol/L， $x ¯$ ±s）	9.35±3.48	9.61±3.28	t=0.398	0.692
TC（mmol/L， $x ¯$ ±s）	4.49±1.36	4.56±1.19	t=0.277	0.782
TG（mmol/L， $x ¯$ ±s）	1.19±0.49	1.14±0.50	t=0.530	0.597
LDL-C（mmol/L， $x ¯$ ±s）	3.51±1.28	3.67±1.56	t=0.543	0.588
HDL-C（mmol/L， $x ¯$ ±s）	1.30±0.39	1.38±0.44	t=1.039	0.303

组别	例数	PVI（%）	CPP（mmHg）
DCI组	32	6.03±2.40	66.53±17.02
非DCI组	114	3.97±2.10	90.24±23.13
t值		4.720	6.394
P值		＜0.001	＜0.001

因素	β值	SE值	Wald χ²值	P值	OR（95%CI）值
Hunt-hess分级	3.464	1.076	10.358	0.001	31.941（3.874~263.318）
WFNS分级	1.022	0.831	1.512	0.219	2.778（0.545~14.158）
改良Fisher分级	1.856	0.936	3.933	0.047	1.156（0.025~0.978）
低蛋白血症	0.207	0.537	0.148	0.700	1.230（0.429~3.527）
PVI	0.414	0.172	5.788	0.016	1.513（1.080~2.119）
CPP	-0.95	0.023	16.855	＜0.001	0.909（0.869~0.952）

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