Inflammation–nutritional profile and functional outcomes in aneurysmal subarachnoid hemorrhage: A single-center retrospective cohort study

Öz

Aim: Aneurysmal subarachnoid hemorrhage (aSAH) remains a major neurovascular emergency associated with high mortality and neurological morbidity. Increasing evidence suggests that systemic inflammatory response and nutritional reserve may influence clinical outcomes after aSAH. The present study aimed to evaluate the relationship between early inflammatory and nutritional biomarkers and clinical outcomes in patients treated with microsurgical clipping for aSAH. Material and Methods: A total of 73 patients who underwent microsurgical clipping for aSAH between January 2021 and December 2025 were retrospectively evaluated. Demographic characteristics, clinical and radiological grading scales, intensive care parameters, and laboratory findings were analyzed. Neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI) were calculated using laboratory data obtained within the first 24 hours after admission. Functional outcomes were assessed using the modified Rankin Scale (mRS). Results: The mean age of the patients was 56.1±12.8 years, and 64.4% were female. CAR was significantly higher in the poor outcome group (p=0.010), whereas NLR showed a borderline increase (p=0.050). SII and SIRI values were higher in the poor outcome group but did not reach statistical significance (p=0.096 and p=0.081, respectively). Multivariate analysis demonstrated that older age, higher World Federation of Neurosurgical Societies (WFNS) score, and elevated CAR level were independent predictors of poor functional outcome. Receiver operating characteristic (ROC) analysis revealed that CAR had one of the highest discriminative performances for predicting poor clinical outcome. Conclusion: Early inflammatory and nutritional biomarkers appear to be associated with clinical prognosis in patients with aSAH treated by microsurgical clipping. Elevated CAR emerged as an independent predictor of poor functional outcome, whereas NLR showed a borderline association with poor outcome. Combined evaluation of inflammatory response and nutritional reserve may provide practical clinical value for early prognostic assessment in patients with aSAH.

Anahtar Kelimeler

• Aneurysmal subarachnoid hemorrhage
• cerebral aneurysm
• inflammation
• neutrophil-to-lymphocyte ratio
• prognosis
• microsurgical clipping

Destekleyen Kurum

No funding was received for this study.

Etik Beyan

This study was approved by the Clinical Research Ethics Committee of University of Health Sciences Türkiye, Prof. Dr. Cemil Taşcıoğlu City Hospital (Approval Date: May 11, 2026; Decision Protocol No: 226; Document No: E-48670771-514.99-314572837).

Teşekkür

None

Anevrizmal subaraknoid kanamada inflamasyon–nutrisyon profili ve fonksiyonel sonuçlar: Tek merkezli retrospektif kohort çalışması

Öz

Amaç: Anevrizmal subaraknoid kanama (aSAK), yüksek mortalite ve morbidite ile ilişkili önemli bir nörovasküler acildir. Son yıllarda sistemik inflamatuvar yanıtın ve nutrisyonel rezervin klinik prognoz üzerindeki etkisi giderek daha fazla dikkat çekmektedir. Bu çalışmada, mikrocerrahi klipleme uygulanan aSAK hastalarında erken dönem inflamatuvar ve nutrisyonel biyobelirteçlerin klinik sonuçlarla ilişkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Ocak 2021–Aralık 2025 tarihleri arasında aSAK nedeniyle mikrocerrahi klipleme uygulanan 73 hasta retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, klinik ve radyolojik derecelendirme sistemleri, yoğun bakım süreçleri ve laboratuvar verileri analiz edildi. Başvuru sonrası ilk 24 saat içerisinde elde edilen laboratuvar parametreleri kullanılarak nötrofil-lenfosit oranı (NLR), sistemik immün-inflamasyon indeksi (SII), sistemik inflamasyon yanıt indeksi (SIRI), C-reaktif protein/albümin oranı (CAR) ve prognostik nutrisyonel indeks (PNI) hesaplandı. Fonksiyonel sonuçlar modified Rankin Scale (mRS) skoruna göre değerlendirildi. Bulgular: Hastaların yaş ortalaması 56.1±12.8 yıl olup olguların %64.4’ü kadındı. Kötü fonksiyonel sonuç grubunda CAR değeri anlamlı olarak daha yüksek bulundu (p=0.010); NLR değeri ise sınırda anlamlılık düzeyinde yüksek izlendi (p=0.050). SII ve SIRI değerleri kötü sonuç grubunda daha yüksek olmakla birlikte istatistiksel anlamlılık düzeyine ulaşmadı (sırasıyla p=0.096 ve p=0.081). PNI değerleri kötü sonuç grubunda daha düşük saptandı ancak anlamlı farklılık izlenmedi. Çok değişkenli analizde ileri yaş, yüksek World Federation of Neurosurgical Societies (WFNS) skoru ve yüksek CAR düzeyi kötü fonksiyonel sonuç açısından bağımsız prediktörler olarak bulundu. Receiver operating characteristic (ROC) analizinde CAR’nin kötü klinik sonlanımı öngörmede en yüksek ayırt edici performansa sahip biyobelirteçlerden biri olduğu görüldü. Sonuç: Mikrocerrahi klipleme uygulanan aSAK hastalarında erken dönem inflamatuvar ve nutrisyonel biyobelirteçler klinik prognoz ile ilişkili görünmektedir. Özellikle yüksek NLR ve CAR değerleri kötü fonksiyonel sonuç ile ilişkili bulunmuştur. İnflamasyon ve nutrisyonel rezervin birlikte değerlendirilmesi, aSAK hastalarında erken dönem prognostik değerlendirme açısından klinik katkı sağlayabilir.

Anahtar Kelimeler

• Anevrizmal subaraknoid kanama
• serebral anevrizma
• inflamasyon
• nötrofil-lenfosit oranı
• prognoz
• mikrocerrahi klipleme

Destekleyen Kurum

Yazarlar, çalışmanın herhangi bir finansman almadığını beyan eder.

Etik Beyan

Çalışma, Sağlık Bilimleri Üniversitesi Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (11.05.2026 tarih ve 226 karar numarası; Evrak Sayı: E-48670771-514.99-314572837).

Teşekkür

YOK

Kaynakça

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