The relationship of inr value with mortality and morbidity in patients with spontaneous aneurysmatic subarachnoid bleeding between 2017-2021 to the emergency medicine clinic

Purpose: Subarachnoid hemorrhage (SAH, Subarachnoid hemorrhage) is bleeding that occurs in the subarachnoid space, the area between the arachnoid membrane and the pia mater surrounding the brain. There are many studies on SAH; However, there are very few studies on the effect of INR (international normalized ratio) value on mortality in SAH. Materials and Methods: The population of the study will consist of patients aged 18 and over who applied to the Adult Emergency Service of Dicle University Medical Faculty Hospital between 01.01.2017-31.01.2021. In this retrospective descriptive study, the files of approximately 150 patients will be scanned. Data obtained from the Department of Neurosurgery Teaching. It will be interpreted by the member. Demographic characteristics (age, gender), vital signs (respiratory rate, pulse rate, saturation, blood pressure, fever, laboratory parameters (wbc, hemoglobin, hematocrit, plt, glucose, sodium, crp, ptt, pt, inr, ck- mb, troponin-ı), disease history, history, gloskow coma scale, localization of the aneurysm, treatment, number of days in hospital and mortality will be examined. The conformity of continuous variables to the normal distribution was examined using the Shapiro-Wilk test. Continuous variables using mean ± standard deviation or median (minimum: maximum) values; categorical variables were expressed as n(%). According to the normality test results, Independent Double Sample t test and Mann Whitney U test were used for comparisons between groups. Categorical variables were analyzed using Chi-square test and Fisher's Exact Chi-square test. SPSS (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) program was used for statistical analysis, and type I error level was accepted as 5% in statistical analysis. Results: When the demographic characteristics of the patients were examined, it was observed that the mean age of the patients who died was higher than the mean age of the patients who survived (p=0.016). When the patients were analyzed according to chronic kidney failure, it was determined that the patients who died were higher than the patients who survived with chronic kidney failure (p=0.009). When the patients were analyzed according to their smoking rates, the rate of smoking was found to be higher in the deceased patient group than in the surviving patient group (p=0.043). According to the neurological evaluation of the patients at admission, the neurological evaluation of the surviving patients was found to be higher than the neurological evaluation of the patients who died (p<0.001). When analyzed according to MCA, the incidence of MCA was found to be higher in patients who died than in patients who survived (p=0.005). According to the whole blood results of the patients, the median leukocyte value was found to be higher in the patients who died than in the patients who survived (p=0.029). The median platelet value was found to be higher in surviving patients than in deceased patients (p=0.035). It was observed that the mean glucose value in the patients who died was higher than the mean glucose value in the patients who survived (p<0.001). When analyzed according to CK-MB value, it was determined that the median CK-MB value of the patients who died was higher than the patients who survived (p=0.016). When analyzed according to the troponin value, it was determined that the median Troponin value of the patients who died was higher than the patients who survived (p=0.003). According to the treatment applied to the patients included in the study, the rate of surgical treatment was found to be higher in surviving patients compared to medical treatment (p<0.001). In the examination of the hospitalization process of the patients included in the study, the median hospitalization day of the patients who survived was found to be higher than the median hospitalization day of the patients who died (p<0.001). Conclusion: Spontaneous aneurysmatic subarachnoid hemorrhages are more common in patients with advanced age and comorbidities. It has been determined that gender, age, and blood pressure values at the time of admission do not affect mortality. It is seen that the prognosis is poor in patients with aneurysm involvement, especially MCA. It is seen that surgical intervention is a positive factor in survival, and the improvement in prognosis increases in direct proportion with the hospitalization period. Further studies and retrospective evaluations are required to examine the effect of INR value, which is the main subject of our study, on mortality. Key words: subarachnoid hemorrhage, aneurysm, INR, mortality