Hokari Masaaki, Uchida Kazuki, Shimbo Daisuke, Gekka Masayuki, Asaoka Katsuyuki, Itamoto Koji
Department of Neurosurgery, Teine Keijinkai Hospital, Maeda 1-12-1-40, Teine-Ku, Sapporo, Hokkaido 006-0811, Japan.
Department of Neurosurgery, Teine Keijinkai Hospital, Maeda 1-12-1-40, Teine-Ku, Sapporo, Hokkaido 006-0811, Japan.
J Clin Neurosci. 2020 Aug;78:108-113. doi: 10.1016/j.jocn.2020.05.055. Epub 2020 Jun 26.
Subarachnoid hemorrhage (SAH) can trigger immune activation sufficient to induce systematic inflammatory response syndrome (SIRS). Serum inflammatory biomarkers and SIRS can predict a poor outcome. The relationship between surgical stress and inflammatory response is well known but described in few reports in the neurosurgical population. We aimed to ascertain whether postoperative SIRS and initial serum biomarkers were associated with outcomes and evaluate whether the postoperative SIRS score differed between those with clipping and coil embolization. We evaluated 87 patients hospitalized within 24 h from onset of nontraumatic SAH. Serum biomarkers, such as levels of C-reactive protein (CRP), white blood cells (WBC), and D-dimer, as well as stress index (SI: blood sugar/K ratio) were obtained at admission. SIRS scores 3 days after admission were derived by adding the number of variables meeting the standard criteria (heart rate [HR] >90, respiratory rate [RR] >20, temperature >38 °C or <36 °C, and WBC count <4000 or >12,000). Clinical variables were compared according to whether they were associated with poor outcomes. Coil embolization was performed in 30 patients and clipping in 57. WBC, SI, D-dimer levels, and SIRS scores were significantly higher in patients with poor-grade SAH and were associated with poor outcomes. SIRS scores were significantly higher with clipping than with coil embolization among patients with good-grade SAH without intracerebral hemorrhage. Acute SIRS and serum biomarkers predict outcomes after SAH. Moreover, our study suggests the influence of surgical invasion via clipping on SIRS after SAH.
蛛网膜下腔出血（SAH）可引发足以诱发全身炎症反应综合征（SIRS）的免疫激活。血清炎症生物标志物和SIRS可预测不良预后。手术应激与炎症反应之间的关系已为人所知，但在神经外科人群中的相关报道较少。我们旨在确定术后SIRS和初始血清生物标志物是否与预后相关，并评估夹闭术和弹簧圈栓塞术患者的术后SIRS评分是否存在差异。我们评估了87例非创伤性SAH发病后24小时内入院的患者。入院时获取血清生物标志物，如C反应蛋白（CRP）、白细胞（WBC）和D-二聚体水平，以及应激指数（SI：血糖/K比值）。入院3天后的SIRS评分通过将符合标准的变量数量相加得出（心率[HR]>90、呼吸频率[RR]>20、体温>38°C或<36°C、白细胞计数<4000或>12000）。根据临床变量是否与不良预后相关进行比较。30例患者接受弹簧圈栓塞术，57例接受夹闭术。SAH分级差的患者白细胞、SI、D-二聚体水平和SIRS评分显著更高，且与不良预后相关。在无脑出血的SAH分级良好的患者中，夹闭术患者的SIRS评分显著高于弹簧圈栓塞术患者。急性SIRS和血清生物标志物可预测SAH后的预后。此外，我们的研究提示了夹闭术所致手术侵袭对SAH后SIRS的影响。
