Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Neurology, University of Texas McGovern Medical School, Houston, Texas, USA.
World Neurosurg. 2021 Jul;151:e803-e809. doi: 10.1016/j.wneu.2021.04.124. Epub 2021 May 5.
An increasing white blood cell (WBC) count in early course of aneurysmal subarachnoid hemorrhage (SAH) can indicate a systemic inflammatory state triggered by the initial insult. We sought to determine the significance of the early WBC trend as a potential predictor of outcomes.
We analyzed a cohort of consecutive patients with aneurysmal SAH. The WBC values in first 5 days of admission, plus relevant clinical and imaging data, and modified Rankin Scale (mRS) at 3 months after hospital discharge were retrieved and analyzed. Favorable outcome was defined as mRS 0-3. The association between WBC counts and outcomes including mRS and delayed cerebral ischemia (DCI) was determined using binary logistic regression models. We used receiver operating characteristic curve analysis to assess accuracy of WBC in predicting outcomes.
We included 167 patients in final analysis. Mean age was 56.4 (standard deviation [SD] 14.8) years, and 65% (109) of patients were female. Peak WBC was greater in patients with poor functional outcome (mean 17 × 10 cells/L, SD 6.4 vs. 13.5 × 10 cells/L SD 4.7). Combining peak WBC with modified Fisher scale slightly increased accuracy in predicting DCI (area under the curve 0.670, 95% confidence interval 0.586-0.755) compared with each component alone.
WBC count in the early course of SAH may have prognostic values in predicting DCI and functional outcome. WBC count monitoring may be used in conjunction with other clinical and radiographic tools to stratify patients with SAH into high- and low-risk groups to tailor neuromonitoring and treatment strategies.
早期蛛网膜下腔出血（SAH）中白细胞（WBC）计数的增加表明初始损伤引发了全身炎症状态。我们试图确定早期 WBC 趋势作为潜在预后预测因子的意义。
我们分析了连续的动脉瘤性 SAH 患者队列。收集并分析了入院后前 5 天的 WBC 值，以及相关的临床和影像学数据，以及出院后 3 个月的改良 Rankin 量表（mRS）评分。良好的预后定义为 mRS 0-3。使用二元逻辑回归模型确定 WBC 计数与包括 mRS 和迟发性脑缺血（DCI）在内的结局之间的关联。我们使用受试者工作特征曲线分析来评估 WBC 预测结局的准确性。
我们最终分析了 167 例患者。平均年龄为 56.4（标准差[SD] 14.8）岁，65%（109）的患者为女性。功能结局不良的患者峰值 WBC 较高（平均 17×10 个细胞/L，SD 6.4 比 13.5×10 个细胞/L，SD 4.7）。与每个单一指标相比，将峰值 WBC 与改良 Fisher 量表相结合略微提高了预测 DCI 的准确性（曲线下面积 0.670，95%置信区间 0.586-0.755）。
SAH 早期的 WBC 计数可能对预测 DCI 和功能结局具有预后价值。WBC 计数监测可与其他临床和影像学工具结合使用，将 SAH 患者分层为高危和低危组，以调整神经监测和治疗策略。
