Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA.
Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA.
World Neurosurg. 2020 Jun;138:e523-e529. doi: 10.1016/j.wneu.2020.02.170. Epub 2020 Mar 6.
Increasing evidence points monocytes' role to be larger than thought in developing cerebral infarction (CI) after subarachnoid hemorrhage (SAH). However, there is no clinical evidence of the relationship between peripheral monocytes and CI and clinical outcomes. Therefore we determine whether an increase in monocytes in the acute phase is useful to predict CI and functional outcomes in SAH patients.
We included 204 patients with an SAH diagnosis. We collected patient-related factors, comorbidities, Hunt-Hess grade, modified Fisher grade, treatment, delayed cerebral ischemia, CI, aneurysm characteristics, and peripheral monocytes from vein blood at admission. Poor outcomes were defined as modified Rankin Scale score ≥3.
Fifty (24.5%) patients had CI before discharge. In a multivariate model, increased monocytes at admission were significantly associated with CI after adjusting for IV-V Hunt-Hess grade and delayed cerebral ischemia (odds ratio: 3.193, 95% confidence interval: 1.069-9.532, P = 0.037). In receiver operating characteristic curve analysis, a monocyte count of 0.60 was identified as the best cutoff value to discriminate the development of CI (area under the curve = 0.622, P = 0.010; CI for monocytes <0.60 17.4% vs. CI for monocytes ≥0.60 29.1% P = 0.046). Admission monocytes ≥0.60 predicted poor functional outcomes at discharge (monocytes <0.60 52% vs. monocytes ≥0.60 64.7%) and at 12 months (monocytes <0.60 29.4% vs. monocytes ≥0.60 70.6%).
Increased peripheral monocytes at admission is a risk factor for developing CI after SAH. Moreover, short- and long-term poor clinical outcomes were associated with higher monocyte count. Therefore monocytes could be a convenient biomarker for prognosis unfavorable outcomes and a possible target for new therapeutic strategies.
越来越多的证据表明，单核细胞在蛛网膜下腔出血（SAH）后形成脑梗死（CI）中的作用比想象的要大。然而，目前还没有外周血单核细胞与 CI 及临床转归之间关系的临床证据。因此，我们旨在确定急性期外周血单核细胞的增加是否有助于预测 SAH 患者的 CI 及临床转归。
我们纳入了 204 例 SAH 患者。我们收集了患者相关因素、合并症、Hunt-Hess 分级、改良 Fisher 分级、治疗、迟发性脑缺血、CI、动脉瘤特征以及入院时静脉血中的外周单核细胞。预后不良定义为改良 Rankin 量表评分≥3 分。
50（24.5%）例患者在出院前发生 CI。多变量模型显示，在校正 IV-V Hunt-Hess 分级和迟发性脑缺血后，入院时外周血单核细胞增多与 CI 显著相关（比值比：3.193，95%置信区间：1.069-9.532，P=0.037）。在受试者工作特征曲线分析中，单核细胞计数 0.60 被确定为区分 CI 发生的最佳截断值（曲线下面积：0.622，P=0.010；单核细胞计数<0.60 组 17.4% vs. 单核细胞计数≥0.60 组 29.1%，P=0.046）。入院时单核细胞计数≥0.60 预测出院时（单核细胞计数<0.60 组 52% vs. 单核细胞计数≥0.60 组 64.7%）和 12 个月时（单核细胞计数<0.60 组 29.4% vs. 单核细胞计数≥0.60 组 70.6%）功能结局不良。
入院时外周血单核细胞增多是 SAH 后发生 CI 的危险因素。此外，短期和长期临床预后不良与单核细胞计数升高相关。因此，单核细胞可能是预后不良结局的一个方便的生物标志物，也是新的治疗策略的一个可能靶点。
