Piffko Andras, Ricklefs Franz L, Schweingruber Nils, Sauvigny Thomas, Mader Marius Marc-Daniel, Mohme Malte, Dührsen Lasse, Westphal Manfred, Regelsberger Jan, Schmidt Nils Ole, Czorlich Patrick
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA.
J Clin Med. 2023 Jan 28;12(3):1006. doi: 10.3390/jcm12031006.
A multitude of pathological and inflammatory processes determine the clinical course after aneurysmal subarachnoid hemorrhage (aSAH). However, our understanding of predictive factors and therapeutic consequences is limited. We evaluated the predictive value of clinically relevant factors readily available in the ICU setting, such as white blood cell (WBC) count and CRP, for two of the leading comorbidities, delayed cerebral ischemia (DCI) and ventriculoperitoneal (VP) shunt dependency in aSAH patients with and without corticosteroid treatment. We conducted a retrospective analysis of 484 aSAH patients admitted to our institution over an eight-year period. Relevant clinical factors affecting the risk of DCI and VP shunt dependency were identified and included in a multivariate logistic regression model. Overall, 233/484 (48.1%) patients were treated with corticosteroids. Intriguingly, predictive factors associated with the occurrence of DCI differed significantly depending on the corticosteroid treatment status (dexamethasone group: Hunt and Hess grade ( = 0.002), endovascular treatment ( = 0.016); no-dexamethasone group: acute hydrocephalus ( = 0.018), peripheral leukocyte count 7 days post SAH (WBC at day 7) ( = 0.009)). Similar disparities were found for VP shunt dependency (dexamethasone group: acute hydrocephalus ( = 0.002); no-dexamethasone group: WBC d7 ( = 0.036), CRP peak within 72 h ( = 0.015)). Our study shows that corticosteroid-induced leukocytosis negates the predictive prognostic potential of systemic inflammatory markers for DCI and VP shunt dependency, which has previously been neglected and should be accounted for in future studies.
多种病理和炎症过程决定了动脉瘤性蛛网膜下腔出血（aSAH）后的临床病程。然而，我们对预测因素和治疗后果的理解有限。我们评估了重症监护病房（ICU）环境中易于获得的临床相关因素，如白细胞（WBC）计数和C反应蛋白（CRP），对aSAH患者在接受和未接受皮质类固醇治疗情况下的两种主要合并症，即迟发性脑缺血（DCI）和脑室腹腔（VP）分流依赖的预测价值。我们对8年间入住我院的484例aSAH患者进行了回顾性分析。确定了影响DCI风险和VP分流依赖的相关临床因素，并将其纳入多变量逻辑回归模型。总体而言，233/484例（48.1%）患者接受了皮质类固醇治疗。有趣的是，根据皮质类固醇治疗状态，与DCI发生相关的预测因素有显著差异（地塞米松组：Hunt和Hess分级（P = 0.002），血管内治疗（P = 0.016）；非地塞米松组：急性脑积水（P = 0.018），蛛网膜下腔出血后7天外周白细胞计数（第7天白细胞）（P = 0.009））。对于VP分流依赖也发现了类似差异（地塞米松组：急性脑积水（P = 0.002）；非地塞米松组：第7天白细胞（P = 0.036），72小时内CRP峰值（P = 0.015））。我们的研究表明，皮质类固醇诱导的白细胞增多消除了全身炎症标志物对DCI和VP分流依赖的预测预后潜力，这一点此前被忽视，在未来研究中应予以考虑。
