Cuoco Joshua A, Guilliams Evin L, Adhikari Srijan, Rogers Cara M, Marvin Eric A, Patel Biraj M, Entwistle John J
Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA.
Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA.
World Neurosurg. 2023 May;173:e378-e390. doi: 10.1016/j.wneu.2023.02.060. Epub 2023 Feb 15.
The authors sought to investigate the association between white blood cell counts and acute hydrocephalus in spontaneous nonaneurysmal subarachnoid hemorrhage (nSAH).
We conducted a retrospective analysis of 105 consecutive patients with spontaneous nSAH. Univariate and multivariable logistic regression analyses were performed to investigate factors associated with hydrocephalus. Receiver operating characteristic curve analysis determined the optimal cutoff to differentiate between patients with and without hydrocephalus. The admission characteristics of hydrocephalic patients with aneurysmal and nSAH were compared.
A total of 70 patients met inclusion criteria, of which 21 (30%) presented with hydrocephalus. In univariate logistic regression, leukocytes, neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, neutrophil-monocyte-to-lymphocyte ratio, and the systemic immune-inflammation (SII) index ([neutrophils × platelets/lymphocytes]/1000) were associated with hydrocephalus. After adjustments, the SII index independently predicted acute hydrocephalus with the highest odds among laboratory values (odds ratio 2.184, P = 0.006). Receiver operating characteristic curve analysis revealed the SII index differentiated between patients with and without hydrocephalus (area under the curve = 0.799, 95% CI: 0.688-0.909, P < 0.001) with an optimal cutoff of 1.385 10/μL. SII indices did not differ between aneurysmal and nSAH patients with hydrocephalus (3.5 vs. 3.6 10/μL, P = 0.795).
A SII index ≥1.385 10/μL on admission predicts acute hydrocephalus in spontaneous nSAH. Hydrocephalic patients with aneurysmal and nSAH exhibit similar SII indices, and thus, an exaggerated inflammatory and thrombotic response follows spontaneous subarachnoid hemorrhage irrespective of hemorrhage etiology.
作者试图研究自发性非动脉瘤性蛛网膜下腔出血（nSAH）患者白细胞计数与急性脑积水之间的关联。
我们对105例连续的自发性nSAH患者进行了回顾性分析。进行单因素和多因素逻辑回归分析以研究与脑积水相关的因素。通过受试者工作特征曲线分析确定区分有无脑积水患者的最佳临界值。比较了动脉瘤性和nSAH脑积水患者的入院特征。
共有70例患者符合纳入标准，其中21例（30%）出现脑积水。在单因素逻辑回归中，白细胞、中性粒细胞、淋巴细胞、中性粒细胞与淋巴细胞比值、淋巴细胞与单核细胞比值、中性粒细胞 - 单核细胞与淋巴细胞比值以及全身免疫炎症（SII）指数（[中性粒细胞×血小板/淋巴细胞]/1000）与脑积水相关。调整后，SII指数在实验室指标中以最高的优势独立预测急性脑积水（优势比2.184，P = 0.006）。受试者工作特征曲线分析显示，SII指数可区分有无脑积水的患者（曲线下面积 = 0.799，95% CI：0.688 - 0.909，P < 0.001），最佳临界值为1.385×10⁹/μL。动脉瘤性和nSAH脑积水患者的SII指数无差异（3.5 vs. 3.6×10⁹/μL，P = 0.795）。
入院时SII指数≥1.385×10⁹/μL可预测自发性nSAH患者的急性脑积水。动脉瘤性和nSAH脑积水患者的SII指数相似，因此，无论出血病因如何，自发性蛛网膜下腔出血后都会出现过度的炎症和血栓形成反应。
