Predicting the development of delayed cerebral ischemia in patients with ruptured arterial aneurysms

Abstract

Introduction. Vasospasm and delayed cerebral ischemia (DCI), which develop after rupture of cerebral arterial aneurysms and their surgical treatment, are serious complications that worsen the clinical outcome of the disease. The ability to predict the risk of developing these complications is an urgent task allowing to reduce neurological deficits and improve the quality of the patients’ life after aneurysm rupture. Aim – to develop a prognostic model for the development of DCI in patients with ruptured cerebral arterial aneurysms based on the study of a complex of clinical manifestations and a number of laboratory parameters. Material and methods. We examined 91 patients with ruptured arterial aneurysms and the development of subarachnoid hemorrhage in the acute period, identifying the main group with the development of DCI (n=67) and the comparison group without DCI (n=24) in the pre- and postoperative periods. Clinical neurological and neuroimaging studies have been carried out. We studied indicators of blood oxygen transport function, platelet aggregation, coagulogram, concentration of nitrates/nitrites (NOx), angiotensin-converting enzyme (ACE) in venous blood in the pre- and postoperative periods. Results. Based on the logistic regression equation, we determined that predictors influencing the probability of DCI development after aneurysm rupture and clipping include a score on the Glasgow Coma Scale (p=0.001), the p50 value is the partial pressure of oxygen in the blood at which hemoglobin is oxygen saturated by 50% (p=0.001), ACE concentration (p=0.013), NOx/ACE index (p=0.001) and the degree of platelet aggregation according to Traptest (p=0.005). The threshold value of the result of the logistic regression equation was 0.58 with a diagnostic sensitivity of 85.4% and specificity of 69.3%, the area under the ROC of the AUC curve was 0.88±0.015 (p<0.001), which indicates the high quality of the constructed model. Conclusion. The developed predictive model of the probability of DCI development in patients with ruptured arterial cerebral aneurysms with a diagnostic efficiency of 88% allows timely identifying patients for whom it is advisable to begin neuroprotective therapy before surgical treatment.