Prognostic Role of Blood Parameters in Subarachnoid Hemorrhage: A Retrospective Study

Abstract

Aim: Subarachnoid hemorrhage (SAH) occurs when cerebral arteries rupture and bleed into the subarachnoid space. It occurs in approximately 2–22 per 10 000 people per year and is fatal. Abnormalities in hemogram and biochemical parameters are poor prognosis criteria in patients with SAH, and our study aimed to determine the importance of blood parameters in predicting 30-day mortality in patients diagnosed with SAH. Method: The data of patients admitted to the emergency department of our hospital between January 2024 and January 2025 with a diagnosis of SAH and admitted to our hospital were retrospectively analyzed. The importance of 30-day mortality and the prediction of prognosis using blood parameters was determined. Results: A total of 62 patient data were obtained, and 51 patients who met the inclusion and exclusion criteria were included in our study. The mean age of our patients was 59 years (19(37.3%) female and 32 (62.7%) male). Five of our patients (9.8%) were deceased. The correlation between parametric blood parameters (Hb; Htc; Plt; MCV; Neu%; PCO2) and mortality was (0.09; 0.068; 0.154, 0.548, 0.632, 0.953), respectively. The relationship between nonparametrically distributed blood parameters (age; WBC; Ure; Kre; Ast; Alt; Glu; Alb) and mortality is (0.692; 0.486; 0.8; 0.849; 0.739; 0.739; 0.669; 0.447; 0.215), respectively. Conclusion: We think that different results may be obtained after classifying SAH patients as traumatic, nontraumatic, adult, pediatric and geriatric rather than as a single group and evaluating inflammatory markers accordingly.

Keywords

• subarachnoid hemorrhage
• blood parameters
• emergency medicine
• prognostic role

References

1. 1. Krzyżewski RM, Kliś KM, Kwinta BM, Stachura K, Guzik TJ, Gąsowski J. High leukocyte count and risk of poor outcome after subarachnoid hemorrhage: A meta-analysis. World Neurosurg. 2020;135:e541–e547.
2. 2. Provencio JJ, Vora N. Subarachnoid hemorrhage and inflammation: Bench to bedside and back. Semin Neurol. 2005;25:435–444.
3. 3. Bacigaluppi S, Ivaldi F, Bragazzi NL, Benvenuto F, Gallo F, D’Andrea A, et al. An early increase of blood leukocyte subsets in aneurysmal subarachnoid hemorrhage is predictive of vasospasm. Front Neurol. 2020;11:587039.
4. 4. Sun M, Tong X, Xue X, Wang K, Jiang P, Liu A. Association of inflammatory trajectory with subarachnoid hemorrhage mortality. Neurosurg Rev. 2024;47(1):256.
5. 5. Moritz S, Warnat J, Bele S, Graf BM, Woertgen C. The prognostic value of NSE and S100B from serum and cerebrospinal fluid in patients with spontaneous subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2010;22(1):21–31.
6. 6. Vega J, Huidobro EJ. Effects of creatine supplementation on renal function. Rev Med Chil. 2019;147(5):628–633.
7. 7. Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, et al. Acute pancreatitis: Diagnosis and treatment. Drugs. 2022;82(12):1251–1276.
8. 8. Raabe A, Kopetsch O, Woszczyk A, Lank J, Gerlach R, et al. Serum S-100B protein as a molecular marker in severe traumatic brain injury. Restor Neurol Neurosci. 2003;21:159–169.

9. 9. van Donkelaar CE, Dijkland SA, van den Bergh WM, Bakker J, Dippel DW, Nijsten MW, et al. Early circulating lactate and glucose levels after aneurysmal subarachnoid hemorrhage correlate with poor outcome and delayed cerebral ischemia: A two-center cohort study. Crit Care Med. 2016;44:966–972.
10. 10. Yüksel U, Öğden M, Akkurt İ, Bakar B, Kısa Ü, Özveren MF. İntrakraniyal kanamaların prognozunda biyokimyasal belirteçler. Cukurova Med J. 2018;43(2):350–359.
11. 11. Behrouz R, Hafeez S, Miller CM. Admission leukocytosis in intracerebral hemorrhage: Associated factors and prognostic implications. Neurocrit Care. 2015;23:370–373.
12. 12. Liu X, Yu Z, Wen D, Ma L, You C. Prognostic value of albumin-fibrinogen ratio in subarachnoid hemorrhage patients. Medicine (Baltimore) . 2021;100(17):e25764.
13. 13. Rajagopal R, Swaminathan G, Nair S, Joseph M. Hyponatremia in traumatic brain injury: A practical management protocol. World Neurosurg. 2017;108:529–533.
14. 14. Höllig A, Remmel D, Stoffel-Wagner B, Schubert GA, Coburn M, Clusmann H. Association of early inflammatory parameters after subarachnoid hemorrhage with functional outcome: A prospective cohort study. Clin Neurol Neurosurg. 2015;138:177–183.
15. 15. Albanna W, Weiss M, Veldeman M, Conzen C, Schmidt T, Blume C, et al. Urea-creatinine ratio (UCR) after aneurysmal subarachnoid hemorrhage: Association of protein catabolism with complication rate and outcome. World Neurosurg. 2021;151:e961–e971.
16. 16. Öğden M. The role of routine biochemical tests in prediction of early prognosis in patients with subarachnoid hemorrhage secondary to middle cerebral artery aneurysm. Kırıkkale Univ Med Fac J. 2019;21(2):202–211.
17. 17. Booker J, Zolnourian A, Street J, Arora M, Pandit AS, Toma A, et al. Quantification of blood and CSF volume to predict outcome after aneurysmal subarachnoid hemorrhage. Neurosurg Rev. 2024;47(1):752.
18. 18. Liao B, Xu Q, Lu P, Zhang Y. The prognostic value of systemic immune-inflammation index in patients with aneurysmal subarachnoid hemorrhage: A systematic review. Neurosurg Rev. 2023;46(1):219.
19. 19. Sun X, Liu X, Liu J, Chen S, Xu D, Li W, et al. Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I-II gastric cancer. Chin J Cancer. 2016;35(1):1–7.
20. 20. Lian L, Xia YY, Zhou C, Shen XM, Li XL, Han SG, et al. Application of platelet/lymphocyte and neutrophil/ lymphocyte ratios in early diagnosis and prognostic prediction in patients with resectable gastric cancer. Cancer Biomark. 2015;15(6):899–907