Abstract：
The relationship between in-hospital hemoglobin (Hb) drift and outcomes in patients undergoing surgical clipping for aneurysmal subarachnoid hemorrhage (aSAH) is not well studied. This study aims to investigate the association between Hb drift and mortality in this patient population. We conducted a cohort study encompassing adult patients diagnosed with aSAH who were admitted to a university hospital. These patients were stratified into distinct groups based on their Hb drift levels. We employed logistic and Cox proportional hazard models to assess the relationship between Hb drift and outcomes. Additionally, propensity score matching (PSM) was utilized to ensure comparability between patient groups. The discriminative performance of different models was evaluated using C-statistics, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Overall, our cohort comprised 671 patients, of whom 165 (24.6%) demonstrated an in-hospital Hb drift exceeding 25%. The analyses revealed elevated Hb drift was independently associated with higher likelihood of follow-up mortality (aOR: 3.29, 95% CI: 1.65 to 6.56; P = 0.001) and in-hospital mortality (aOR: 3.44, 95% CI: 1.55 to 7.63; P = 0.002). PSM analysis yielded similar results. Additionally, patients with Hb drift exhibited a notable decrease in survival rate compared to those without Hb drift (aHR: 3.99, 95% CI 2.30 to 6.70; P < 0.001). Furthermore, the inclusion of Hb drift significantly improved the C-statistic (P = 0.037), IDI (2.78%; P = 0.004) and NRI metrics (41.86%; P < 0.001) for mortality prediction. In summary, our results highlight that an in-hospital Hb drift exceeding 25% serves as an independent predictor of mortality in patients who have undergone surgical clipping for aSAH.
摘要：
院内血红蛋白（Hb）漂移与动脉瘤性蛛网膜下腔出血（aSAH）手术夹闭患者预后之间的关系尚未得到很好的研究。这项研究旨在调查该患者人群中Hb漂移与死亡率之间的关系。我们进行了一项队列研究，包括被诊断为aSAH并被大学医院收治的成年患者。根据Hb漂移水平将这些患者分为不同的组。我们采用Logistic和Cox比例风险模型来评估Hb漂移与结果之间的关系。此外,使用倾向评分匹配(PSM)来确保患者组之间的可比性.使用C统计量评估了不同模型的判别性能，综合歧视改进(IDI)，和净重新分类改进(NRI)。总的来说,我们的队列包括671名患者，其中165人(24.6%)在医院内Hb漂移超过25%。分析显示，Hb漂移升高与随访死亡率（aOR：3.29，95％CI：1.65至6.56；P=0.001）和住院死亡率（aOR：3.44，95％CI：1.55至7.63；P=0.002）较高的可能性独立相关。PSM分析产生类似的结果。此外,与无Hb漂移的患者相比,有Hb漂移的患者生存率显著降低(aHR:3.99,95%CI2.30~6.70;P<0.001).此外，Hb漂移的纳入显着改善了C统计量（P=0.037），IDI(2.78%;P=0.004)和NRI指标(41.86%;P<0.001)用于死亡率预测。总之,我们的结果强调,在接受aSAH手术夹闭的患者中,超过25%的院内Hb漂移是死亡率的独立预测因子.
