Yagi Kenji, Kanda Eiichiro, Hijikata Yasukazu, Tao Yoshifumi, Hishikawa Tomohito
Department of Neurosurgery, Kawasaki Medical School, Kurashiki , Okayama , Japan.
Department of Medical Science, Kawasaki Medical School, Kurashiki , Okayama , Japan.
Neurosurgery. 2025 Jun 1;96(6):1301-1306. doi: 10.1227/neu.0000000000003229. Epub 2024 Oct 11.
Symptomatic chronic subdural hematoma (CSDH) is caused by repetitive hemorrhage and inflammation, which is commonly treated with burr-hole surgery and has a relatively high postoperative recurrence rate. A decrease in the platelet count is indicative of a hemorrhagic tendency, while an increase in the eosinophil count is associated with inflammation. Assessing the balance between platelet-associated hemostasis and eosinophil-associated inflammation using the indeterminate biomarker, the eosinophil-platelet ratio (EPR), may be essential. Therefore, in this study, the accuracy of the EPR in predicting postoperative CSDH recurrence was evaluated and their correlation was determined.
Data on symptomatic CSDHs of the cerebral hemisphere of patients who underwent burr-hole surgery at our institution between January 2013 and December 2022 were retrospectively reviewed. The EPR was calculated from preoperative peripheral blood examination data, and its correlation with postoperative CSDH recurrence was assessed. The hemispheres with CSDH were categorized into recurrence and nonrecurrence cohorts.
Data from 459 cerebral hemispheres of 405 patients with symptomatic CSDH were analyzed. In the 459 cerebral hemispheres with CSDH, 39 (8.5%) had postoperative recurrence. CSDH patients with a high EPR (≥1 × 10 -3 ) had a significantly higher recurrent rate than those with a low EPR (<1 × 10 -3 ) (15 of 86 [17.4%] vs 24 of 373 [6.4%], P = .002). In the modified Poisson regression analysis, the crude and adjusted risk ratios of high EPR were 2.79 (95% CI: 1.53, 5.09) and 2.62 (95% CI: 1.40, 4.89), respectively.
This study reveals that a high EPR is a useful predictive biomarker for postoperative CSDH recurrence. Cases of CSDH with a high EPR potentially require careful and close postoperative follow-up.
有症状的慢性硬膜下血肿（CSDH）由反复出血和炎症引起，通常采用钻孔手术治疗，术后复发率相对较高。血小板计数降低表明有出血倾向，而嗜酸性粒细胞计数增加与炎症相关。使用不确定生物标志物嗜酸性粒细胞 - 血小板比率（EPR）评估血小板相关止血与嗜酸性粒细胞相关炎症之间的平衡可能至关重要。因此，在本研究中，评估了EPR预测术后CSDH复发的准确性并确定了它们之间的相关性。
回顾性分析2013年1月至2022年12月在我院接受钻孔手术的患者大脑半球有症状CSDH的数据。根据术前外周血检查数据计算EPR，并评估其与术后CSDH复发的相关性。将有CSDH的半球分为复发组和非复发组。
分析了405例有症状CSDH患者的459个大脑半球的数据。在459个有CSDH的大脑半球中，39个（8.5%）术后复发。EPR高（≥1×10⁻³）的CSDH患者复发率明显高于EPR低（<1×10⁻³）的患者（86例中有15例[17.4%] vs 373例中有24例[6.4%]，P = 0.002）。在修正的泊松回归分析中，高EPR的粗风险比和调整后风险比分别为2.79（95%CI：1.53，5.09）和2.62（95%CI：1.40，4.89）。
本研究表明，高EPR是术后CSDH复发的有用预测生物标志物。EPR高的CSDH病例术后可能需要仔细密切随访。
