Serum Lactate Dehydrogenase to Phosphate Ratio as an Independent Predictor for Adverse Outcome of Microsurgical Clipping for Ruptured Intracranial Aneurysm: A Retrospective Study

Abstract Objective: We assessed the correlation between lactate dehydrogenase(LDH) to phosphate ratio and the prognosis of microsurgically clipping for ruptured intracranial aneurysm (rIA) in this study, to test the hypothesis that serum LDH to phosphate ratio could be a predictor for the outcome of microsurgically clipping for rIA. Methods: The rIA patients between 2012 and 2018 were retrospectively collected. Age, sex, Hunt-Hess(H-H) grade, Fisher grade, smoking, drink, medical history, aneurysm location, hydrocephalus, laboratory data including serum LDH, phosphate and LDH to phosphate ratio, related complication 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. A significantly higher LDH- phosphate ratio on admission was observed in patients with poor outcome at 3 months (median±SD, 200.175±107.290 for mRS 0–2 vs 323.826±219.075 for mRS score 3–6; P <0.001). A LDH to phosphate ratio of 226.25 in the receiver operating characteristic (ROC) curve was identified as optimal cutoff value to discriminate between good and poor outcome at 3 months. LDH to phosphate ratio≥226.25 on admission was independently correlated with poor outcome in rIA patients. In addition, H-H grade, Fisher grade, pneumonia and DIND were also independently correlated with poor outcome. After removing the bias in basic clinical variables between patients with LDH to phosphate ratio≥226.25 versus <226.25 by PSM, the number of patients with poor outcome at 3 months was obviously increased in patients with LDH to phosphate ratio≥226.25 ( P =0.005). Conclusions: LDH to phosphate ratio was a potential biomarker and could predict the unfavorable outcome of microsurgically clipping for rIA in 3 months. However, the detailed mechanism remain unclear and the conclusion needs be further confirmed by large-scale randomized clinical trials.