Department of Doctoral Studies, Riga Stradins University, 16 Dzirciema Str., 1007 Riga, Latvia.
Riga East University Hospital, 2 Hipokrata Str., 1079 Riga, Latvia.
Medicina (Kaunas). 2022 Feb 21;58(2):323. doi: 10.3390/medicina58020323.
: Secondary cerebral vasospasm (CV) with subsequent delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) remains an unpredictable pathology. The aim of this retrospective study was to investigate the association between inflammatory parameters, white blood cell (WBC) count, and C-reactive protein plasma levels (CRP) and the occurrence of secondary CV in patients with aSAH. : The medical records of 201 Intensive Care Unit patients in Riga East University Hospital with aSAH were retrospectively reviewed in a 24-month period. WBC count and CRP values were observed at admission to the hospital and on the third day. According to the inclusion criteria, 117 (48 males) participants were enrolled for further analysis, with average age of 56 ± 15 years (mean ± SD). In total, secondary CV was diagnosed in 21.4% of cases, and DCI in 22.4% of cases. The patients were classified into three groups: SAH-CV group ( = 25), SAH-DCI group ( = 12), and SAH or control group ( = 80), for comparative analysis. : We found that SAH-CV patients demonstrated notably higher inflammatory parameters compared to controls: WBC 13.2 ± 3.3 × 10/L vs. 11.2 ± 3.7 × 10/L; = 0.01 and CRP median 9.3 mg/L vs. 1.9 mg/L; < 0.001, respectively. We found that the odds of developing CV increased by 5% for each CRP increase of 1 mg/L at admission (OR, 1.05; CI, 1.014-1.087; = 0.006). Concomitantly, the odds increased by 16% for every rise in WBC count of 1 × 10/L (OR, 1.16; CI, 1.02-1.32; = 0.02). WBC count was associated with the occurrence of CV with 96% sensitivity and 40% specificity, with a cut off level of 10.015 × 10/L and AUC 0.683; = 0.006. CRP displayed 54% sensitivity and 90% specificity with a cut off value of 8.9 mg/L and AUC 0.751; < 0.001. Moreover, higher values of inflammatory parameters at admission correlated with a longer stay in ICU (r = 0.3, = 0.002 for WBC count and r = 0.305, = 0.002 for CRP values), and poor outcome (death) was significantly associated with higher CRP values at admission and on the third day (16.1. vs. 2.2. and 57.4. vs. 11.1, < 0.001, respectively). Higher mortality was detected in SAH-CV patients (32%) compared to controls (6.3%; < 0.001). : Inflammatory parameters such as WBC count and CRP values at admission might be helpful to predict the development of secondary CV.
: 二次性大脑血管痉挛（CV）并随后发生的迟发性脑缺血（DCI）是动脉瘤性蛛网膜下腔出血（aSAH）后一种不可预测的病理情况。本回顾性研究的目的是探讨炎症参数、白细胞（WBC）计数和 C 反应蛋白（CRP）血浆水平与 aSAH 患者发生继发性 CV 的关系。 : 在 24 个月的时间内，回顾性分析了里加东大学医院 201 例重症监护病房的 aSAH 患者的病历。入院时和入院第 3 天观察 WBC 计数和 CRP 值。根据纳入标准，纳入了 117 名（48 名男性）参与者进行进一步分析，平均年龄为 56 ± 15 岁（均值 ± 标准差）。总共诊断出 21.4%的病例存在继发性 CV，22.4%的病例存在 DCI。将患者分为三组：SAH-CV 组（ = 25）、SAH-DCI 组（ = 12）和 SAH 或对照组（ = 80），进行比较分析。 : 我们发现，与对照组相比，SAH-CV 患者的炎症参数明显更高：WBC 13.2 ± 3.3×10/L 比 11.2 ± 3.7×10/L； = 0.01 和 CRP 中位数 9.3 mg/L 比 1.9 mg/L； < 0.001，分别。我们发现，入院时 CRP 每增加 1mg/L，发生 CV 的几率增加 5%（OR，1.05；95%CI，1.014-1.087； = 0.006）。同时，WBC 计数每增加 1×10/L，发生 CV 的几率增加 16%（OR，1.16；95%CI，1.02-1.32； = 0.02）。WBC 计数与 CV 的发生具有 96%的敏感性和 40%的特异性，截断值为 10.015×10/L，AUC 为 0.683； = 0.006。CRP 显示 54%的敏感性和 90%的特异性，截断值为 8.9 mg/L，AUC 为 0.751； < 0.001。此外，入院时较高的炎症参数值与 ICU 住院时间较长（WBC 计数 r = 0.3， = 0.002，CRP 值 r = 0.305， = 0.002）和不良预后（死亡）显著相关（入院时 CRP 值为 16.1.比 2.2.和第 3 天 CRP 值为 57.4.比 11.1； < 0.001，分别）。与对照组（6.3%； < 0.001）相比，SAH-CV 患者的死亡率（32%）更高。 : 入院时的白细胞（WBC）计数和 CRP 值等炎症参数可能有助于预测继发性 CV 的发生。
