Biomarkers associated with admission rupture status of intracranial aneurysms: a combined analysis of morphological, inflammatory and coagulation indicators
- 1Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine
Abstract
Background: Spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by intracranial aneurysm (IA) rupture. As a critical neurological emergency with rapid clinical deterioration, SAH is life-threatening and associated with high mortality and disability rates. Early and accurate discrimination of ruptured status is essential for the emergency management of intracranial aneurysms.
Objective: This study aimed to screen admission inflammatory and coagulation biomarkers associated with IA rupture status and construct a comprehensive diagnostic model to distinguish ruptured from unruptured intracranial aneurysms.
Methods: A single-center retrospective analysis was conducted on 167 patients with intracranial aneurysms admitted to the Department of Neurosurgery from January 2020 to September 2025. Patients were divided into a ruptured group (119 cases) and an unruptured group (48 cases) based on intraoperative and imaging findings. Baseline clinical, morphological, hematological and coagulation data were collected. LASSO regression was used for preliminary variable screening. Firth-penalized multivariate logistic regression was further applied to screen independent correlates of aneurysm rupture status and eliminate collinear and insignificant indicators. Finally, a three-variable combined model incorporating aneurysm morphology, white blood cell count, and D-dimer level was established. ROC curve analysis, 1,000-bootstrap calibration curve, and decision curve analysis (DCA) were performed to evaluate the discriminative ability, calibration consistency, and clinical net benefit of the model.
Results: Irregular aneurysm morphology (OR = 37.13, 95%CI:7.26–189.75, p < 0.001), elevated white blood cell count (OR = 15.34, 95%CI:2.12–110.94, p < 0.001), and increased D-dimer level (OR = 12.27, 95%CI:2.26–66.70, p < 0.001) were independent biomarkers associated with ruptured IA status. After excluding collinear neutrophil counts, the final combined model achieved an AUC of 0.96. Bootstrap internal validation demonstrated excellent calibration with a mean absolute error of 0.017. DCA verified that the model yielded favorable clinical net benefit within a reasonable threshold probability range.
Conclusion: Irregular aneurysm morphology, elevated white blood cell count, and increased D-dimer level at admission are independent biomarkers distinguishing ruptured from unruptured intracranial aneurysms. The multi-index combined model shows good discriminative performance, stable calibration, and promising clinical utility, which can provide objective auxiliary evidence for the rapid identification of aneurysm rupture status in neurosurgical emergency settings.
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BibTeX
@article{liu2026biomarkers,
title = {{Biomarkers associated with admission rupture status of intracranial aneurysms: a combined analysis of morphological, inflammatory and coagulation indicators}},
author = {Pan Liu and Yunxiang Wang and Zhiqiang Zhao and Xiao Liu and Quan Ren and Zhengang Tang and Junjie Luo},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1934306},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1934306/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Biomarkers associated with admission rupture status of intracranial aneurysms: a combined analysis of morphological, inflammatory and coagulation indicators
AU - Pan Liu
AU - Yunxiang Wang
AU - Zhiqiang Zhao
AU - Xiao Liu
AU - Quan Ren
AU - Zhengang Tang
AU - Junjie Luo
PY - 2026
DA - 2026/10/21
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1934306
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1934306/full
AB - Background: Spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by intracranial aneurysm (IA) rupture. As a critical neurological emergency with rapid clinical deterioration, SAH is life-threatening and associated with high mortality and disability rates. Early and accurate discrimination of ruptured status is essential for the emergency management of intracranial aneurysms. Objective: This study aimed to screen admission inflammatory and coagulation biomarkers associated with IA rupture status and construct a comprehensive diagnostic model to distinguish ruptured from unruptured intracranial aneurysms. Methods: A single-center retrospective analysis was conducted on 167 patients with intracranial aneurysms admitted to the Department of Neurosurgery from January 2020 to September 2025. Patients were divided into a ruptured group (119 cases) and an unruptured group (48 cases) based on intraoperative and imaging findings. Baseline clinical, morphological, hematological and coagulation data were collected. LASSO regression was used for preliminary variable screening. Firth-penalized multivariate logistic regression was further applied to screen independent correlates of aneurysm rupture status and eliminate collinear and insignificant indicators. Finally, a three-variable combined model incorporating aneurysm morphology, white blood cell count, and D-dimer level was established. ROC curve analysis, 1,000-bootstrap calibration curve, and decision curve analysis (DCA) were performed to evaluate the discriminative ability, calibration consistency, and clinical net benefit of the model. Results: Irregular aneurysm morphology (OR = 37.13, 95%CI:7.26–189.75, p < 0.001), elevated white blood cell count (OR = 15.34, 95%CI:2.12–110.94, p < 0.001), and increased D-dimer level (OR = 12.27, 95%CI:2.26–66.70, p < 0.001) were independent biomarkers associated with ruptured IA status. After excluding collinear neutrophil counts, the final combined model achieved an AUC of 0.96. Bootstrap internal validation demonstrated excellent calibration with a mean absolute error of 0.017. DCA verified that the model yielded favorable clinical net benefit within a reasonable threshold probability range. Conclusion: Irregular aneurysm morphology, elevated white blood cell count, and increased D-dimer level at admission are independent biomarkers distinguishing ruptured from unruptured intracranial aneurysms. The multi-index combined model shows good discriminative performance, stable calibration, and promising clinical utility, which can provide objective auxiliary evidence for the rapid identification of aneurysm rupture status in neurosurgical emergency settings.
SN - 1664-2295
ER -