Barić Hrvoje, Komljenović Sara, Bilić Katarina, Migo William, Vitowanu Julius Mautin, Desnica Andrej, Mrak Goran
Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia.
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
Asian J Neurosurg. 2024 Sep 10;19(4):735-740. doi: 10.1055/s-0044-1790237. eCollection 2024 Dec.
Chronic subdural hematoma (cSDH) is common, predominantly affects the elderly, often recurs after treatment, and can have serious complications, including death. Inflammation plays an important role in cSDH and it has been previously shown that some laboratory indices are useful as prognostic markers. The aim was to research the role of hematologic and inflammatory markers in cSDH. A single-center archival database review to retrieve data on cSDH cases operated on between 2018 and 2020, including: (1) sociodemography (age, gender), (2) clinics (Glasgow Coma Score [GCS], anticoagulants, chronic conditions), (3) laboratory (leukocyte, neutrophil, platelet, C-reactive protein, hemoglobin, red cell distribution width [RDW], neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio [PLR], systemic immune-inflammatory index [SII]), (4) cSDH (size, location, midline shift), and (5) treatment (craniotomy/craniostomy, drainage). Primary outcome was Glasgow Outcome Score (GOS) at discharge and at 1 year, and secondary outcomes were 1 year mortality, resurgery, and recurrence. Hematological and inflammatory indices were compared across two cSDH thickness groups. Seventy-two patients were included, 25 women and 47 men, median age 77 years. Seventeen (23.6%) patients had chronic anticoagulant treatment. The majority had a chronic comorbidity: 19 (26.4%) diabetes, 48 (66.7%) hypertension, and 56 (77.8%) other chronic diseases. Median preoperative GCS was 15. Median cSDH thickness was 22.9 mm, sidedness was equally distributed, and midline shift occurred in 60 (83.3 %) patients, with median midline shift of 8.4 mm. The majority of patients underwent a single craniostomy ( = 44, 61.1%), and in all patients a subdural drainage was placed. Median GOS at discharge and at 1 year postoperatively was 5. Mortality was 11.1%, and 16.7% of patients were lost to follow-up. Within the 1-year follow-up, 27.8% of patients had disease recurrence, 25% underwent a repeat surgery. In the "above" versus "below" 15 mm cSDH thickness group there were significant differences in P count (211.5 vs. 279.5 × 10 /L, = 0.009), RDW (13.3 vs. 12.6, = 0.031), SII (1782 vs. 2653, = 0.025), and PLR (26.2 vs. 36.7, = 0.042). Hematological indices bear a diagnostic and prognostic potential in cSDH management.
慢性硬膜下血肿（cSDH）很常见，主要影响老年人，治疗后常复发，并可出现严重并发症，包括死亡。炎症在cSDH中起重要作用，先前已有研究表明一些实验室指标可作为预后标志物。本研究旨在探讨血液学和炎症标志物在cSDH中的作用。
通过单中心存档数据库回顾，检索2018年至2020年间接受手术治疗的cSDH病例数据，包括：（1）社会人口统计学特征（年龄、性别）；（2）临床情况（格拉斯哥昏迷评分[GCS]、抗凝剂使用情况、慢性病）；（3）实验室检查结果（白细胞、中性粒细胞、血小板、C反应蛋白、血红蛋白、红细胞分布宽度[RDW]、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值[PLR]、全身免疫炎症指数[SII]）；（4）cSDH情况（大小、位置、中线移位）；（5）治疗方式（开颅手术/颅骨钻孔术、引流）。主要结局指标为出院时及术后1年的格拉斯哥预后评分（GOS），次要结局指标为1年死亡率、再次手术率和复发率。比较两个cSDH厚度组的血液学和炎症指标。
共纳入72例患者，其中女性25例，男性47例，中位年龄77岁。17例（23.6%）患者接受慢性抗凝治疗。大多数患者患有慢性合并症：19例（26.4%）患有糖尿病，48例（66.7%）患有高血压，56例（77.8%）患有其他慢性病。术前中位GCS为15分。cSDH中位厚度为22.9mm，双侧分布均等，60例（83.3%）患者出现中线移位，中位中线移位为8.4mm。大多数患者接受了单次颅骨钻孔术（n = 44，61.1%），所有患者均进行了硬膜下引流。出院时及术后1年的中位GOS为5分。死亡率为11.1%，16.7%的患者失访。在1年随访期内，27.8%的患者疾病复发，25%的患者接受了再次手术。在cSDH厚度“大于”与“小于”15mm的组间，血小板计数（211.5对279.5×10⁹/L，P = 0.009）、RDW（13.3对12.6，P = 0.031）、SII（1782对2653，P = 0.025）和PLR（26.2对36.7，P = 0.042）存在显著差异。
血液学指标在cSDH的管理中具有诊断和预后潜力。
