Relationship between cystatin C/prealbumin ratio and cerebral vasospasm in patients with intracranial aneurysmal subarachnoid hemorrhage

DENG Weining; LI Jingyuan; SUN Qiang; ZHANG Xiaogang; ZHU Runmei; ZHOU Ke

Abstract：Objective To explore the relationship between serum cystatin C(CysC)/prealbumin(PA)ratio and cerebral vasospasm(CVS)in cases with intracranial aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 120 cases with aSAH admitted to Affiliated Baoji Hospital of Xi'an Medical University and Hanzhong Central Hospital from January 2020 to May 2024 were retrospectively analyzed.Digital subtraction angiography or transcranial Doppler flow analysis showed that 37 patients developed CVS(hence included in the CVS group)and the other 83 patients did not develop CVS(hence included in the non-CVS group).Clinical data and serum CysC,PA levels of all subjects were collected at admission,and their CysC/PA were calculated.The value of CysC/PA in evaluating concurrent CVS in aSAH patients were evaluated by ROC and AUC,and the influencing factors of concurrent CVS in aSAH patients were explored by multi-factor logistics regression.Results CysC and CysC/PA in CVS group were higher than those in non-CVS group,and PA was lower than those in non-CVS group(P＜0.05).The AUC(95%CI)of CysC,PA and CysC/PA for aSAH patients with CVS were 0.749(0.704-0.799),0.806(0.756-0.856)and 0.912(0.867-0.957),respectively.The aneurysms located in anterior cerebral artery,Fisher grade Ⅳ,Hunt-Hess grade Ⅲ-Ⅳ,and the number of hypertension and hyperlipidemia in CVS group was higher than those in non-CVS group(P＜0.05).Multivariate regression analysis showed that Fisher grade Ⅳ(OR=2.776,95%CI:1.387-5.556),Hunt-Hess grade Ⅲ-Ⅳ(OR=2.347,95%CI:1.372-4.015),CysC≥2.29 mg/L(OR=2.654,95%CI:1.273-5.534),PA＜127.74 mg/L(OR=2.555,95%CI:1.441-4.528)and CysC/PA≥1.47(OR=4.175,95%CI:1.998-8.723)were the influencing factors of CVS in aSAH patients(P＜0.05).Conclusions The elevated CysC/PA ratio is closely related to the occurrence of CVS in aSAH patients,and is expected to be used as an indicator to evaluate the potential risk of CVS in aSAH patients.