Cuoco Joshua A, Guilliams Evin L, Klein Brendan J, Witcher Mark R, Marvin Eric A, Patel Biraj M, Entwistle John J
Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.
Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States.
Front Surg. 2022 Apr 28;9:879050. doi: 10.3389/fsurg.2022.879050. eCollection 2022.
The authors sought to evaluate whether immunologic counts on admission were associated with shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage. A retrospective analysis of 143 consecutive patients with aneurysmal subarachnoid hemorrhage over a 9-year period was performed. A stepwise algorithm was followed for external ventricular drain weaning and determining the necessity of shunt placement. Data were compared between patients with and without shunt-dependent hydrocephalus. Overall, 11.19% of the cohort developed shunt-dependent hydrocephalus. On multivariate logistic regression analysis, acute hydrocephalus (OR: 61.027, 95% CI: 3.890-957.327; = 0.003) and monocyte count on admission (OR: 3.362, 95% CI: 1.024-11.037; = 0.046) were found to be independent predictors for shunt dependence. Receiver operating characteristic curve analysis for the prediction of shunt-dependent hydrocephalus confirmed that monocyte count exhibited an acceptable area under the curve (AUC = 0.737, 95% CI: 0.601-0.872; < 0.001). The best predictive cutoff value to discriminate between successful external ventricular drain weaning and shunt-dependent hydrocephalus was identified as a monocyte count ≥0.80 × 10/uL at initial presentation. These preliminary data demonstrate that a monocyte count ≥0.80 × 10/uL at admission predicts shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage; however, further large-scale prospective trials and validation are necessary to confirm these findings.
作者试图评估动脉瘤性蛛网膜下腔出血患者入院时的免疫指标计数是否与分流依赖型脑积水有关。对9年间连续收治的143例动脉瘤性蛛网膜下腔出血患者进行了回顾性分析。采用逐步算法进行脑室外引流撤机并确定是否需要放置分流管。对有和没有分流依赖型脑积水的患者的数据进行了比较。总体而言，该队列中有11.19%的患者发生了分流依赖型脑积水。多因素逻辑回归分析显示，急性脑积水（比值比：61.027，95%置信区间：3.890 - 957.327；P = 0.003）和入院时单核细胞计数（比值比：3.362，95%置信区间：1.024 - 11.037；P = 0.046）是分流依赖的独立预测因素。用于预测分流依赖型脑积水的受试者工作特征曲线分析证实，单核细胞计数的曲线下面积可接受（曲线下面积 = 0.737，95%置信区间：0.601 - 0.872；P < 0.001）。区分成功的脑室外引流撤机和分流依赖型脑积水的最佳预测临界值确定为初始就诊时单核细胞计数≥0.80×10⁹/L。这些初步数据表明，动脉瘤性蛛网膜下腔出血患者入院时单核细胞计数≥0.80×10⁹/L可预测分流依赖型脑积水；然而，需要进一步的大规模前瞻性试验和验证来证实这些发现。
