Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.
Department of Neurosurgery, Macheng People's Hospital, Macheng, Hubei, 438300, China.
Clin Neurol Neurosurg. 2022 Jan;212:107087. doi: 10.1016/j.clineuro.2021.107087. Epub 2021 Dec 7.
Neuroinflammatory response is deemed the primary pathogenesis of delayed cerebral ischemia (DCI) caused by aneurysmal subarachnoid hemorrhage (aSAH). Both white blood cell (WBC) count and Hounsfield Unit (HU) are gradually considered can reflect inflammation in DCI. This study aims to identify the relationship between WBC count and HU value and investigate the effects of both indicators in predicting DCI after aSAH.
We enrolled 109 patients with aSAH admitted within 24 h of onset in our study. A multivariate logistic regression analysis was used to evaluate the admission WBC count, HU value, and combined WBC-HU associated with DCI. The receiver operating characteristic curve and area under the curve (AUC) were used to determine thresholds and detect the predictive ability of these predictors. These indicators were also compared with the established inflammation markers.
Thirty-six (33%) patients developed DCI. Both WBC count and HU value were strongly associated with the admission glucose level (ρ = .303, p = .001; ρ = .273, p = .004), World Federation of Neurosurgical Societies grade (ρ = .452, p < .001; ρ = .578; p < .001), Hunt-Hess grade (ρ = .450, p < .001; ρ = .510, p < .001), and modified Fisher scale score (ρ = .357, p < .001; ρ = .330, p < .001). After controlling these public variables, WBC count (ρ = .300, p = .002) positively correlated with HU value. An early elevated WBC (odds ratio [OR] 1.449, 95% confidence interval [CI]: 1.183-1.774, p < .001) count and HU value (OR 1.304, 95%CI: 1.149-1.479, p < .001) could independently predict the occurrence of DCI. However, only these patients with both WBC count and HU value exceeding the cut-off points (OR 36.89, 95%CI: 5.606-242.78, p < .001) were strongly correlated with DCI. Compared with a single WBC count (AUC 0.811, 95%CI: 0.729-0.892, p < .001) or HU value (AUC 0.869, 95%CI: 0.803-0.936, p < .001), the combined WBC-HU (AUC 0.898, 95%CI: 0.839-0.957, p < .001) demonstrated a better ability to predict the occurrence of DCI. Inspiringly, the prediction performance of these indicators outperformed the established inflammatory markers.
An early elevated WBC count and HU value could independently predict DCI occurrence between 4 and 30 days after aSAH. Furthermore, WBC count was positively correlated with HU value, and the combined WBC-HU demonstrated a superior prediction ability for DCI development compared with the individual indicator.
神经炎症反应被认为是蛛网膜下腔出血（aSAH）后迟发性脑缺血（DCI）的主要发病机制。白细胞（WBC）计数和亨斯菲尔德单位（HU）逐渐被认为可以反映 DCI 中的炎症。本研究旨在确定 WBC 计数与 HU 值之间的关系，并探讨这两个指标在预测 aSAH 后 DCI 中的作用。
我们纳入了 109 例发病 24 小时内的 aSAH 患者。采用多变量逻辑回归分析评估入院时的 WBC 计数、HU 值以及与 DCI 相关的 WBC-HU 联合指标。采用受试者工作特征曲线和曲线下面积（AUC）确定这些预测因子的截断值和检测预测能力。这些指标与已建立的炎症标志物进行比较。
36 例（33%）患者发生 DCI。WBC 计数和 HU 值均与入院时血糖水平（ρ=0.303，p=0.001；ρ=0.273，p=0.004）、世界神经外科学会分级（ρ=0.452，p<0.001；ρ=0.578；p<0.001）、Hunt-Hess 分级（ρ=0.450，p<0.001；ρ=0.510，p<0.001）和改良 Fisher 分级评分（ρ=0.357，p<0.001；ρ=0.330，p<0.001）密切相关。在控制这些公共变量后，WBC 计数（ρ=0.300，p=0.002）与 HU 值呈正相关。早期升高的 WBC（比值比[OR] 1.449，95%置信区间[CI]：1.183-1.774，p<0.001）计数和 HU 值（OR 1.304，95%CI：1.149-1.479，p<0.001）可独立预测 DCI 的发生。然而，只有同时存在 WBC 计数和 HU 值超过临界值的患者（OR 36.89，95%CI：5.606-242.78，p<0.001）与 DCI 密切相关。与单一的 WBC 计数（AUC 0.811，95%CI：0.729-0.892，p<0.001）或 HU 值（AUC 0.869，95%CI：0.803-0.936，p<0.001）相比，WBC-HU 联合（AUC 0.898，95%CI：0.839-0.957，p<0.001）具有更好的预测 DCI 发生的能力。令人鼓舞的是，这些指标的预测性能优于已建立的炎症标志物。
早期升高的 WBC 计数和 HU 值可独立预测 aSAH 后 4-30 天 DCI 的发生。此外，WBC 计数与 HU 值呈正相关，与单一指标相比，WBC-HU 联合具有更好的 DCI 预测能力。
