Krzyżewski Roger M, Kliś Kornelia M, Kwinta Borys M, Stachura Krzysztof, Guzik Tomasz J, Gąsowski Jerzy
Department of Neurosurgery and Neurotraumatolgy, Jagiellonian University Medical College, Kraków, Poland; TENSOR-Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.
TENSOR-Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland; Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; AGH University of Science and Technology, Faculty of Computer Science, Electronics and Telecommunications, Kraków, Poland.
World Neurosurg. 2020 Mar;135:e541-e547. doi: 10.1016/j.wneu.2019.12.056. Epub 2019 Dec 19.
Subarachnoid hemorrhage is (SAH) is a devastating neurologic emergency often associated with systemic inflammatory response. Many reports have demonstrated an association between elevated inflammatory markers and poor outcome. We performed an observational study and a meta-analysis of the impact of high leukocyte count on outcome after SAH.
We initially retrospectively analyzed 147 patients with SAH through assessment of medical records database. Poor outcome was defined as modified Rankin Scale score >3. Then, we performed a systematic literature search of PubMed, EMBASE, and the Cochrane Library. Prospective and retrospective studies were included if they assessed impact of leukocytosis on outcome after aneurysmal SAH in adults. We used a random-effect model and quality-effect model, based on the study quality assessment tool, an adapted version of inventory to assess quality of intervention studies.
Within our initial observational study, a total of 63 (42.86%) patients had poor treatment outcome. Those patients significantly more often had elevated white blood cell count upon admission (60.32 vs. 40.48%; P = 0.02). A literature search identified 10,119 articles, of which 13 were included into the meta-analysis. Pooled impact of high leukocyte count on outcome was odds ratio 1.42 (95% confidence interval 1.24-1.63) for random-effect model and OR 1.86 (95% confidence interval 1.46-2.36) for the quality-effect model. However, the studies were heterogenous (I = 54%).
Elevated white blood cells is a marker of poor outcome after SAH. Despite the fact that it is unlikely to be causative, it may be treated as a useful risk predictor.
蛛网膜下腔出血（SAH）是一种严重的神经系统急症，常伴有全身炎症反应。许多报告表明炎症标志物升高与不良预后相关。我们进行了一项观察性研究和一项关于高白细胞计数对SAH后预后影响的荟萃分析。
我们最初通过评估病历数据库对147例SAH患者进行回顾性分析。不良预后定义为改良Rankin量表评分>3。然后，我们对PubMed、EMBASE和Cochrane图书馆进行了系统的文献检索。纳入前瞻性和回顾性研究，条件是它们评估了白细胞增多对成人动脉瘤性SAH后预后的影响。我们使用随机效应模型和质量效应模型，基于研究质量评估工具，即干预研究质量评估量表的改编版来评估研究质量。
在我们最初的观察性研究中，共有63例（42.86%）患者治疗效果不佳。这些患者入院时白细胞计数升高的情况明显更常见（60.32%对40.48%；P = 0.02）。文献检索共识别出10119篇文章，其中13篇纳入荟萃分析。随机效应模型中高白细胞计数对预后的综合影响为比值比1.42（95%置信区间1.24 - 1.63），质量效应模型为比值比1.86（95%置信区间1.46 - 2.36）。然而，这些研究存在异质性（I² = 54%）。
白细胞升高是SAH后不良预后的一个标志物。尽管它不太可能是病因，但可作为一个有用的风险预测指标。
