Relationship between postoperative blood uric acid level and short-term prognosis of patients with spontaneous subarachnoid hemorrhage
Objective To observe the changes in blood uric acid level after operation in patients with spontaneous subarachnoid hemorrhage(SAH)and its relationship with the short-term prognosis.Methods Totally 100 patients with spontaneous SAH were diagnosed and treated in Zhoukou Central Hospital from February 2021 to April 2023.All patients underwent operation within 5 days after admission.The blood uric acid level was detected on postoperative day 1,3,5,7 and 14.According to the Glasgow Outcome Scale(GOS)score 3 months after operation,100 patients were divided into 28 patients with GOS score ≤3(poor prognosis group)and 72 patients with GOS＞3(good prognosis group).The clinical data including comorbidities,Hunt-Hess grade,Fisher grade,complications within 14 days after operation,and postoperative blood uric acid level were compared between two groups.Multivariate logistic regression analysis was done to evaluate the influencing factors of poor prognosis 3 months after operation in spontaneous SAH patients.The ROC curve was plotted to evaluate the efficiency of postoperative blood uric acid on predicting poor prognosis 3 months after operation in spontaneous SAH patients.Results The proportions of intraventricular hemorrhage,intracranial hemorrhage,Hunt-Hess grade Ⅳ-Ⅴ,Fisher grade Ⅲ-Ⅳ,postoperative delayed cerebral ischemia,and in-hospital rebleeding were higher in poor prognosis group(32.14％,25.00％,42.86％,64.29％,25.00％,35.71％)than those in good prognosis group(4.17％,4.17％,8.33％,13.89％,6.94％,12.50％)(x2=14.942,9.722,16.280,25.398,6.224,7.059;all P values＜0.05).The blood uric acid levels were higher in poor prognosis group on postoperative day 1,3,5,7 and 14[(485.89±120.43),(569.43±145.83),(479.83±115.69),(402.94±106.41),(342.85±92.83)μmol/L]than those in good prognosis group[(425.84±109.14),(372.09±98.26),(328.69±94.31),(281.37±86.22),(240.59±81.32)μmol/L](t=2.400,7.815,6.742,6.919,5.424;all P values＜0.05).Intraventricular hemorrhage(OR=3.483,95％CI:1.231-9.852,P＜0.001),intracranial hemorrhage(OR=3.497,95％CI:1.075-11.374,P＜0.001),Hunt-Hess grade(OR=4.997,95％CI:1.362-18.337,P＜0.001),Fisher grade(OR=4.433,95％CI:1.275-15.413,P＜0.001),postoperative delayed cerebral ischemia(OR=10.080,95％CI:3.251-31.255,P＜0.001),in-hospital rebleeding(OR=8.654,95％CI:2.111-35.478,P＜0.001),blood uric acid level on postoperative day 1(OR=1.506,95％CI:1.013-2.056,P＜0.001),blood uric acid level on postoperative day 3(OR=1.489,95％CI:1.020-2.174,P＜0.001),blood uric acid level on postoperative day 5(OR=1.501,95％CI:1.022-2.204,P＜0.001),blood uric acid level on postoperative day 7(OR=1.509,95％CI:1.024-2.225,P＜0.001),and blood uric acid level on postoperative day 14(OR=1.553,95％CI:1.031-2.338,P＜0.001)were the influencing factors of poor prognosis 3 months after operation in spontaneous SAH patients.When the optimal cut-off values of blood uric acid levels on postoperative day 1,3,5,7 and 14 were 478.47,549.01,459.41,380.58 and 273.02 μmol/L,the AUCs for predicting poor prognosis 3 months after operation were 0.748(95％CI:0.651-0.830,P＜0.001),0.758(95％CI:0.662-0.838,P＜0.001),0.781(95％CI:0.687-0.858,P＜0.001),0.802(95％CI:0.710-0.875,P＜0.001),and 0.831(95％CI:0.743-0.899,P＜0.001),with the sensitivities of 71.43％,75.00％,67.86％,75.00％and 89.29％,and the specificities of 79.17％,75.00％,80.56％,83.33％and 75.28％,respectively.The AUC of blood uric acid on postoperative day 14 was higher than that of blood uric acid on postoperative day 1,3,5 and 7 for predicting poor prognosis 3 months after operation(Z=4.535,P＜0.001;Z=4.656,P＜0.001;Z=5.240,P＜0.001;Z=5.504,P＜0.001).Conclusions The spontaneous SAH patients have an increased risk of poor short-term prognosis after operation when they are complicated with intraventricular hemorrhage,intracranial hemorrhage,postoperative delayed cerebral ischemia,postoperative in-hospital rebleeding,high Hunt-Hess and Fisher grades,and elevated postoperative blood uric acid level.The blood uric acid level on postoperative day 14 has a high value to the prediction of poor short-term prognosis.
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