Serum Lactate Dehydrogenase to Phosphate Ratio as an Independent Predictor for Adverse Outcome of Microsurgical Clipping for Ruptured Intracranial Aneurysm: A Propensity-Score Matching Analysis

Shufa Zheng; Yibin Zhang; Haojie Wang; Xueling Xie; Yuanxiang Lin; Peisen Yao; Zhangya Lin; Dezhi Kang

doi:10.3390/brainsci12060737

Serum Lactate Dehydrogenase to Phosphate Ratio as an Independent Predictor for Adverse Outcome of Microsurgical Clipping for Ruptured Intracranial Aneurysm: A Propensity-Score Matching Analysis

Brain Sci. 2022 Jun 4;12(6):737. doi: 10.3390/brainsci12060737.

Authors

Shufa Zheng¹, Yibin Zhang¹, Haojie Wang¹, Xueling Xie¹, Yuanxiang Lin¹, Peisen Yao¹, Zhangya Lin¹, Dezhi Kang^{1

2

3

4

5

6}

Affiliations

¹ Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China.
² Fujian Provincial Clinical Research Center for Neurological Disease, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China.
³ Department of Neurosurgery, Binhai Branch of National Regional Medical Center, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China.
⁴ Fujian Provincial Institutes of Brain Disorders and Brain Sciences, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China.
⁵ Clinical Research and Translation Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, China.
⁶ The First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou 350004, China.

Abstract

Objective: In this study, we assessed the correlation between the lactate dehydrogenase (LDH) to phosphate ratio and the prognosis of microsurgical clippings for ruptured intracranial aneurysm (rIA) to test the hypothesis that the serum LDH to phosphate ratio could be a predictor of the outcome of microsurgical clipping for rIA. Methods: Records of rIA patients between 2012 and 2018 were retrospectively collected. Age, sex, Hunt-Hess grade, Fisher grade, medical history, aneurysm location, hydrocephalus, laboratory data including serum LDH, phosphate, and LDH to phosphate ratio, related complications, and the outcomes in 3 months were recorded. Results: A total of 1608 rIA patients in our institution were collected, and 856 patients treated by microsurgical clipping were enrolled. On admission, a significantly higher LDH-phosphate ratio was observed in patients with poor outcomes at 3 months (median ± SD, 200.175 ± 107.290 for mRS 0−2 vs. 323.826 ± 219.075 for mRS score 3−6; p = 0.000). An LDH to phosphate ratio of 226.25 in the receiver operating characteristic (ROC) curve was the optimal cutoff value to discriminate between good and poor outcomes at 3 months. The LDH to phosphate ratio ≥ 226.25 on admission was independently correlated with poor outcomes in rIA patients. In addition, Hunt and Hess grade, Fisher grade, pneumonia, and DIND were also independently correlated with poor outcomes. After removing the bias in essential clinical variables between patients with LDH to phosphate, ratio ≥ 226.25 versus <226.25 by PSM, the number of patients with poor outcomes at 3 months increased in patients with an LDH to phosphate ratio of ≥226.25 (p = 0.005). Conclusions: The LDH to phosphate ratio was a potential biomarker and could predict the unfavorable outcome of microsurgical clipping for rIA in 3 months, related to neuronal damage, cerebral hypoxia, and early brain injury after aneurysm ruptures.

Keywords: aneurysmal subarachnoid hemorrhage; biomarker; lactate dehydrogenase; microsurgical clipping; outcome; phosphate.

Grants and funding

They are supported by the Fujian clinical research center for neurological disease (SSJ-YJZX-1 to De-Zhi Kang), critical clinical specialty discipline construction program of Fujian, P.R.C, the major project of Fujian provincial department of science and technology (No.2014YZ0003 and No. 2014YZ01 to De-Zhi Kang), the Young and Middle-aged Backbone Key Research Project of National Health and Family Planning Commission of Fujian Province (No. 2017-ZQN-46 to Pei-Sen Yao), Natural Science Funding of Fujian Province (No. 2018J01175 to Pei-Sen Yao and No. 2018J01176 to Shu-Fa Zheng).This research received no external funding.