Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2024 May;185:e342-e350. doi: 10.1016/j.wneu.2024.02.001. Epub 2024 Feb 8.
This study investigated the prognostic value of admission blood counts for arteriovenous malformation (AVM) outcomes and compared admission blood counts for patients with ruptured and unruptured AVMs.
A retrospective analysis of patients who underwent surgical treatment for a ruptured cerebral AVM between February 1, 2014, and March 31, 2020, was conducted. The primary outcome was poor neurologic outcome, defined as a modified Rankin Scale score ≥2 in patients with unruptured AVMs or >2 in patients with ruptured AVMs.
Of 235 included patients, 80 (34%) had ruptured AVMs. At admission, patients with ruptured AVMs had a significantly lower mean (SD) hemoglobin level (12.78 [2.07] g/dL vs. 13.71 [1.60] g/dL, P < 0.001), hematocrit (38.1% [5.9%] vs. 40.7% [4.6%], P < 0.001), lymphocyte count (16% [11%] vs. 26% [10%], P < 0.001), and absolute lymphocyte count (1.41 [0.72] × 10/μL vs. 1.79 [0.68] × 10/μL, P < 0.001), and they had a significantly higher mean (SD) white blood cell count (10.4 [3.8] × 10/μL vs. 7.6 [2.3] × 10/μL, P < 0.001), absolute neutrophil count (7.8 [3.8] × 10/μL vs. 5.0 [2.5] × 10/μL, P < 0.001), and neutrophil count (74% [14%] vs. 64% [13%], P < 0.001). Among patients with unruptured AVMs, white blood cell count ≥6.4 × 10/μL and absolute neutrophil count ≥3.4 × 10/μL were associated with a favorable neurologic outcome, whereas hemoglobin level ≥13.4 g/dL was associated with an unfavorable outcome. Among patients with ruptured AVMs, hypertension was associated with a 3-fold increase in odds of a poor neurologic outcome.
Patients with ruptured and unruptured AVMs present with characteristic profiles of hematologic and inflammatory parameters evident in their admission blood work.
本研究旨在探讨入院时血液计数对动静脉畸形（AVM）预后的预测价值，并比较破裂和未破裂 AVM 患者的入院血液计数。
对 2014 年 2 月 1 日至 2020 年 3 月 31 日期间接受手术治疗的破裂脑 AVM 患者进行回顾性分析。主要结局为不良神经结局，定义为未破裂 AVM 患者的改良 Rankin 量表评分≥2 分或破裂 AVM 患者的评分>2 分。
在 235 例纳入的患者中，80 例（34%）患有破裂性 AVM。入院时，破裂性 AVM 患者的平均（标准差）血红蛋白水平明显较低（12.78[2.07]g/dL 比 13.71[1.60]g/dL，P<0.001）、血细胞比容（38.1%[5.9%]比 40.7%[4.6%]，P<0.001）、淋巴细胞计数（16%[11%]比 26%[10%]，P<0.001）和绝对淋巴细胞计数（1.41[0.72]×10/μL 比 1.79[0.68]×10/μL，P<0.001），白细胞计数（10.4[3.8]×10/μL 比 7.6[2.3]×10/μL，P<0.001）、绝对中性粒细胞计数（7.8[3.8]×10/μL 比 5.0[2.5]×10/μL，P<0.001）和中性粒细胞计数（74%[14%]比 64%[13%]，P<0.001）明显较高。在未破裂 AVM 患者中，白细胞计数≥6.4×10/μL 和绝对中性粒细胞计数≥3.4×10/μL 与良好的神经结局相关，而血红蛋白水平≥13.4g/dL 与不良结局相关。在破裂性 AVM 患者中，高血压与不良神经结局的发生几率增加 3 倍相关。
破裂和未破裂 AVM 患者的入院血液检查表现出特征性的血液学和炎症参数特征。
