Shin Kyung Won, Park Eun Bi, Jo Woo-Young, Lee Hyung-Chul, Park Hee-Pyoung, Oh Hyongmin
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Neurosurg Anesthesiol. 2025 Apr 1;37(2):216-224. doi: 10.1097/ANA.0000000000000977. Epub 2024 Jun 17.
Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (ASAH) is a serious complication and has a strong relationship with systemic inflammatory responses. Given previously reported relationships between leukocytosis and anemia with ASAH-related cerebral vasospasm, this study examined the association between the preoperative white blood cell-to-hemoglobin ratio (WHR) and postoperative symptomatic cerebral vasospasm (SCV) in patients with ASAH.
Demographic, preoperative (comorbidities, ASAH characteristics, laboratory findings), intraoperative (operation and anesthesia), and postoperative (SCV, other neurological complications, clinical course) data were retrospectively analyzed in patients with ASAH who underwent surgical or endovascular treatment of the culprit aneurysm. Patients were divided into high-WHR (n=286) and low-WHR (n=257) groups based on the optimal cutoff value of preoperative WHR (0.74), and stabilized inverse probability weighting was performed between the 2 groups. The predictive power of the WHR and other preoperative systemic inflammatory indices (neutrophil-to-albumin, neutrophil-to-lymphocyte, platelet-to-lymphocyte, platelet-to-neutrophil, platelet-to-white blood cell ratios, and systemic immune-inflammation index) for postoperative SCV was evaluated.
Postoperative SCV was more frequent in the high-WHR group than in the low-WHR group before (33.2% vs. 12.8%; P <0.001) and after (29.4% vs. 19.1%; P =0.005) inverse probability weighting. Before weighting, the predictive power for postoperative SCV was the highest for the WHR among the preoperative systematic inflammatory indices investigated (area under receiver operating characteristics curve 0.66, P <0.001). After weighting, preoperative WHR ≥0.74 was independently associated with postoperative SCV (odds ratio 1.76; P =0.006).
High preoperative WHR was an independent predictor of postoperative SCV in patients with ASAH.
动脉瘤性蛛网膜下腔出血（ASAH）后的脑血管痉挛是一种严重的并发症，与全身炎症反应密切相关。鉴于先前报道的白细胞增多症和贫血与ASAH相关脑血管痉挛之间的关系，本研究探讨了ASAH患者术前白细胞与血红蛋白比值（WHR）与术后症状性脑血管痉挛（SCV）之间的关联。
对接受责任动脉瘤手术或血管内治疗的ASAH患者的人口统计学、术前（合并症、ASAH特征、实验室检查结果）、术中（手术和麻醉）及术后（SCV、其他神经并发症、临床病程）数据进行回顾性分析。根据术前WHR的最佳截断值（0.74）将患者分为高WHR组（n = 286）和低WHR组（n = 257），并在两组之间进行稳定的逆概率加权。评估WHR和其他术前全身炎症指标（中性粒细胞与白蛋白比值、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值、血小板与中性粒细胞比值、血小板与白细胞比值以及全身免疫炎症指数）对术后SCV的预测能力。
在逆概率加权之前（33.2%对12.8%；P <0.001）和之后（29.4%对19.1%；P = 0.005），高WHR组术后SCV的发生率均高于低WHR组。在加权之前，在所研究的术前系统性炎症指标中，WHR对术后SCV的预测能力最高（受试者操作特征曲线下面积为0.66，P <0.001）。加权后，术前WHR≥0.74与术后SCV独立相关（比值比为1.76；P = 0.006）。
术前高WHR是ASAH患者术后SCV的独立预测因素。
