Di-san junyi daxue xuebao (May 2021)
Correlation between changes of brain volume and prognosis after aneurysmal subarachnoid hemorrhage
Abstract
Objective To investigate the rule of change of brain volume (COBV) in 1 week after aneurysmal subarachnoid hemorrhage (aSAH), and determine the influences of COBV and change rate of brain volume (CRBV) on the prognosis of patients. Methods The clinical data of spontaneous aSAH patients admitted to the Neurosurgery Intensive Care Unit (NSICU) of the First Affiliated Hospital of Chongqing Medical University from January to August 2019 were retrospectively collected and analyzed. 3D-Slicer biomedical image computing platform was used to measure the brain volume (BV) on the 1st, 5th and 7th days after hemorrhage according to CT scans. The COBV was defined as maximum brain volume (BVmax) minus minimum brain volume (BVmin) within 1 week after bleeding, and the CRBV was the proportion of the COBV to the volume of cranial cavity×100%. According to the results of modified Rankin scale (mRS) in 3 months after bleeding, the patients were divided into good prognosis group (mRS: 1~2) and poor prognosis group (mRS: 3~5). Multivariate logistic regression analysis was adopted to analyze the independent risk factors for poor prognosis. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of COBV and CRBV for poor prognosis. Results For the 89 enrolled aSAH patients, the BV on the 5th day after hemorrhage (early stage after aSAH) was 1 193.9±108.7 mL, significantly larger than those at the other 2 time points (P < 0.05). Multivariate logistic regression analysis showed that COBV and CRBV were independent risk factors for poor prognosis in the patients. ROC curve analysis indicated that for COBV and CRBV, the area under curve (AUC) was 0.878 and 0.882, the best predictive cut-off values were 72.1 mL and 5.6%, with a sensitivity of 79.4% and 79.4% and specificity of 87.3% and 89.1%, respectively. Conclusion In the early stage of aSAH, the BV on the 5th day is significantly larger than that on the 1st and 7th days after hemorrhage. COBV and CRBV are independent risk factors for poor prognosis in aSAH patients.
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