Department of Neurosurgery, Fuzong Clinical College of Fujian Medical University, 900 Hospital, Fuzhou, China.
Department of Microbiology and Immunology & Key Immunopathology Laboratory of Guangdong Province, Shantou University Medical College, Shantou, China.
Ann Clin Transl Neurol. 2023 Jul;10(7):1058-1071. doi: 10.1002/acn3.51789. Epub 2023 May 17.
The aim of this study was to examine the predictive value of the multiplication of neutrophil and monocyte counts (MNM) in peripheral blood, and develop a new predictive model for the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH).
This is a retrospective analysis that included 2 separate cohorts of patients undergoing endovascular coiling for aSAH. The training cohort consisted of 687 patients in the First Affiliated Hospital of Shantou University Medical College; the validation cohort consisted of 299 patients from Sun Yat-sen University's Affiliated Jieyang People's Hospital. The training cohort was used to develop 2 models to predict unfavorable prognosis (modified Rankin scale of 3-6 at 3 months): one was based on traditional factors (e.g., age, modified Fisher grade, NIHSS score, and blood glucose), and another model that included traditional factors as well as MNM on admission.
In the training cohort, MNM upon admission was independently associated with unfavorable prognosis (odds ratio after adjustment, 1.06; 95% confidence interval [CI], 1.03-1.10). In the validation cohort, the basic model that included only traditional factors had 70.99% sensitivity, 84.36% specificity, and 0.859 (95% CI, 0.817-0.901) area under the receiver operating characteristic curve (AUC). Adding MNM increased model sensitivity (from 70.99% to 76.48%), specificity (from 84.36% to 88.63%), and overall performance (AUC 0.859 [95% CI, 0.817-0.901] to 0.879 [95% CI, 0.841-0.917]).
MNM upon admission is associated with unfavorable prognosis in patients undergoing endovascular embolization for aSAH. The nomogram including MNM is a user-friendly tool to help clinicians quickly predict the outcome of patients with aSAH.
本研究旨在探讨外周血中性粒细胞与单核细胞计数（MNM）乘积对颅内动脉瘤性蛛网膜下腔出血（aSAH）患者预后的预测价值，并建立新的预测模型。
本研究为回顾性分析，纳入 2 项分别对行血管内栓塞治疗的 aSAH 患者的队列研究。训练队列包括汕头大学医学院第一附属医院的 687 例患者；验证队列包括中山大学附属揭阳人民医院的 299 例患者。训练队列用于建立预测预后不良（3 个月时改良 Rankin 量表 3-6 分）的 2 个模型：一个基于传统因素（如年龄、改良 Fisher 分级、NIHSS 评分和血糖），另一个模型包括入院时的传统因素和 MNM。
在训练队列中，入院时的 MNM 与预后不良独立相关（调整后的优势比，1.06；95%置信区间 [CI]，1.03-1.10）。在验证队列中，仅包含传统因素的基本模型的敏感性为 70.99%，特异性为 84.36%，曲线下面积（AUC）为 0.859（95% CI，0.817-0.901）。加入 MNM 提高了模型的敏感性（从 70.99%提高至 76.48%）、特异性（从 84.36%提高至 88.63%）和整体性能（AUC 从 0.859[95% CI，0.817-0.901]提高至 0.879[95% CI，0.841-0.917]）。
入院时的 MNM 与接受血管内栓塞治疗的 aSAH 患者的不良预后相关。包含 MNM 的列线图是一种方便临床医生快速预测 aSAH 患者结局的工具。
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