Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Education, Beijing Tiantan Hospital, the Fifth Clinical Medical College, Capital Medical University, Beijing, China.
Neurosurg Rev. 2024 Jun 5;47(1):256. doi: 10.1007/s10143-024-02413-0.
White blood cells (WBC) play an important role in the inflammatory response of the body. Elevated WBC counts on admission in patients with subarachnoid hemorrhage (SAH) correlate with a poor prognosis. However, the role of longitudinal WBC trajectories based on repeated WBC measurements during hospitalization remains unclear. We explored the association between different WBC trajectory patterns and in-hospital mortality.
We analyzed a cohort of consecutive patients with SAH between 2012 and 2020. Group-based trajectory modeling (GBTM) was used to group the patients according to their white blood cell patterns over the first 4 days. Stabilized inverse probability treatment weighting (sIPTW) was used to balance baseline demographic and clinical characteristics. We analyzed the association between the WBC trajectory groups and in-hospital mortality using a Cox proportional hazards model.
In total, 506 patients with SAH were included in this retrospective cohort. The final model identified two distinct longitudinal WBC trajectories. After adjusting for confounding factors, multivariate regression analysis suggested that an elevated longitudinal WBC trajectory increased the risk of in-hospital mortality (hazard ratio [HR], 2.476; 95% confidence interval [CI] 1.081-5.227; P = 0.024) before sIPTW, and (HR, 2.472; 95%CI 1.489-4.977; P = 0.018) after sIPTW.
In patients with SAH, different clinically relevant groups could be identified using WBC trajectory analysis. The WBC count trajectory-initially elevated and then decreased- may lead to an increased risk of in-hospital mortality following SAH.
白细胞（WBC）在机体炎症反应中发挥重要作用。蛛网膜下腔出血（SAH）患者入院时白细胞计数升高与预后不良相关。然而，基于住院期间重复白细胞测量的纵向白细胞轨迹的作用尚不清楚。我们探讨了不同白细胞轨迹模式与住院期间死亡率之间的关系。
我们分析了 2012 年至 2020 年间连续收治的 SAH 患者队列。使用基于群组的轨迹建模（GBTM）根据患者入院后前 4 天的白细胞模式对患者进行分组。使用稳定的逆概率处理加权（sIPTW）平衡基线人口统计学和临床特征。我们使用 Cox 比例风险模型分析白细胞轨迹组与住院期间死亡率之间的关系。
共纳入 506 例 SAH 回顾性队列患者。最终模型确定了两种不同的纵向白细胞轨迹。在调整混杂因素后，多变量回归分析表明，升高的纵向白细胞轨迹增加了住院期间死亡率的风险（危险比[HR]，2.476；95%置信区间[CI]，1.081-5.227；P=0.024），在 sIPTW 之前，和（HR，2.472；95%CI，1.489-4.977；P=0.018）之后。
在 SAH 患者中，可使用白细胞轨迹分析确定不同的临床相关组。白细胞计数轨迹-最初升高然后降低-可能导致 SAH 后住院期间死亡率增加。
