E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: The Role of Surgical Timing and InflammatoryMetabolic Markers
MEHMET EMRE YILDIRIM✉ ,
BERKAY AYHAN: ,
RIFAT OZTURK ,
EDIP RENCUZOGULLARI ,
MELİH UTKU OZCAN ,
HAYDAR CELIK ,
YAVUZ ERDEM ,
AYHAN TEKİNER
DOI: 10.5137/1019-5149.JTN.50414-25.3
Article in Press
Corresponding Author:
MEHMET EMRE YILDIRIM (memrenrs@gmail.com)
Abstract
Aim
Delayed cerebral ischemia (DCI) influences poor outcome after subarachnoid hemorrhage (SAH). We evaluated the prognostic value of clinical variables, inflammatory and metabolic markers, and surgical timing for DCI in aneurysmal and nonaneurysmal SAH.
Material and Methods
We retrospectively analyzed 166 consecutive patients with spontaneous SAH (20152025) and categorized them into surgically treated aneurysmal SAH group (n = 88) or medically managed nonaneurysmal SAH group (n = 78). DCI was defined as new foca deficit and/or decreased consciousness ≥1 hour between days 314 after excluding rebleeding, hydrocephalus, seizures, infection, electrolyte imbalance, or other confounders. Extreme in-hospital laboratory values were extracted: minimum sodium (Na_min), maximum C-reactive protein (CRP_max), peak white blood cell count (WBC_peak), and maximum temperature (Tmax). Surgical timing (days) was classified as early (05), intermediate (615), or late (≥16). DCI predictors were assessed using multivariable logistic regression with prespecified clinical thresholds and 5-fold internal cross-validation.
Results
DCI incidence was 5.7% and 3.8% in the surgical and medical groups, respectively. Late surgery group exhibited highest DCI incidence (46.1% vs. 3.8% in the early surgery group; p = 0.009). Independent predictors of DCI were CRP_max ≥60 mg/L ( p = 0.002), Na_min <135 mmol/L ( p = 0.01), Tmax ≥ 38.3°C ( p = 0.008), and surgical delay ≥10 days ( p = 0.004). Combined CRPNa model showed strong discrimination (area under the curve = 0.90; 5-fold cross-validation), and surgical delay correlated with longer hospitalization (Pearson r = 0.42; p = 0.001).
Conclusion
Beyond angiographic vasospasm, systemic inflammation and electrolyte imbalance substantially contribute to DCI. Early surgical intervention, alongside close monitoring and prompt correction of elevated CRP, hyponatremia, and fever may mitigate DCI risk. The pragmatic CRPNa model is a low-cost tool for early DCI risk stratification.
Delayed cerebral ischemia (DCI) influences poor outcome after subarachnoid hemorrhage (SAH). We evaluated the prognostic value of clinical variables, inflammatory and metabolic markers, and surgical timing for DCI in aneurysmal and nonaneurysmal SAH.
Material and Methods
We retrospectively analyzed 166 consecutive patients with spontaneous SAH (20152025) and categorized them into surgically treated aneurysmal SAH group (n = 88) or medically managed nonaneurysmal SAH group (n = 78). DCI was defined as new foca deficit and/or decreased consciousness ≥1 hour between days 314 after excluding rebleeding, hydrocephalus, seizures, infection, electrolyte imbalance, or other confounders. Extreme in-hospital laboratory values were extracted: minimum sodium (Na_min), maximum C-reactive protein (CRP_max), peak white blood cell count (WBC_peak), and maximum temperature (Tmax). Surgical timing (days) was classified as early (05), intermediate (615), or late (≥16). DCI predictors were assessed using multivariable logistic regression with prespecified clinical thresholds and 5-fold internal cross-validation.
Results
DCI incidence was 5.7% and 3.8% in the surgical and medical groups, respectively. Late surgery group exhibited highest DCI incidence (46.1% vs. 3.8% in the early surgery group; p = 0.009). Independent predictors of DCI were CRP_max ≥60 mg/L ( p = 0.002), Na_min <135 mmol/L ( p = 0.01), Tmax ≥ 38.3°C ( p = 0.008), and surgical delay ≥10 days ( p = 0.004). Combined CRPNa model showed strong discrimination (area under the curve = 0.90; 5-fold cross-validation), and surgical delay correlated with longer hospitalization (Pearson r = 0.42; p = 0.001).
Conclusion
Beyond angiographic vasospasm, systemic inflammation and electrolyte imbalance substantially contribute to DCI. Early surgical intervention, alongside close monitoring and prompt correction of elevated CRP, hyponatremia, and fever may mitigate DCI risk. The pragmatic CRPNa model is a low-cost tool for early DCI risk stratification.
Keywords
Subarachnoid Hemorrhage
Vasospasm
Ischemia