Postma Eva, Labib Homeyra, van Lange Jordi, Coert Bert, Post René, van den Berg René, Majoie Charles, Vandertop W Peter, Verbaan Dagmar
Amsterdam UMC, Location AMC, University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands.
Amsterdam UMC, Location AMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands.
Brain Spine. 2025 Mar 13;5:104236. doi: 10.1016/j.bas.2025.104236. eCollection 2025.
Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) contributes significantly to mortality and morbidity. Neuroinflammation and platelet activation are implicated in its pathophysiology.
This study evaluates the association of admission white blood cell count (WBC) and platelet count (PC), and their combination, with DCI and explores their integration into predictive models.
This single-center cohort study utilized data from a prospective SAH registry (December 2011-December 2019). Patients with confirmed aSAH and recorded WBC and PC within 72 h post-ictus were included. Univariate and multivariate regression models with established predictors, consisting of the modified Fisher scale (mFS) and World Federation of Neurological Surgeons grade (WFNS), were performed. Predictive values were assessed using AUCs (95 % CI) and C-statistics.
Of 954 reviewed patients, 660 met inclusion criteria, with 178 (27.0 %) developing DCI. Patients who developed DCI had significantly higher admission WBC levels (mean (SD) 14.3 (5.1) × 10/L vs. 12.7 (4.8) × 10/L, p < 0.001), whereas admission PC did not differ significantly (median (IQR) 255 (201-301) × 10/L vs. 241 (205-289) × 10/L, p = 0.196). WBC was predictive of DCI (OR 1.06, 1.03-1.10), but PC was not (OR 1.00, 1.00-1.02). Of established predictors, mFS was significant (OR 6.42, 1.96-21.02), whereas WFNS was not (OR 0.79, 0.54-1.15). Among all variables, WBC demonstrated highest predictive value (AUC: 0.59, 0.54-0.64), surpassing mFS and WFNS, or their combination. A combined model incorporating WBC, PC, mFS, and WFNS yielded the highest predictive value (AUC: 0.63, 0.58-0.68).
Admission WBC and PC offer modest predictive value for DCI, either alone or combined with neurological status and hemorrhage burden. However, WBC demonstrated highest predictive value of all investigated variables and modestly improves prediction models. Future research should evaluate WBC's utility in models with enhanced predictive performance.
动脉瘤性蛛网膜下腔出血（aSAH）后的迟发性脑缺血（DCI）是导致死亡率和发病率的重要因素。神经炎症和血小板活化参与了其病理生理过程。
本研究评估入院时白细胞计数（WBC）和血小板计数（PC）及其联合指标与DCI的相关性，并探讨将它们纳入预测模型的可能性。
这项单中心队列研究使用了前瞻性SAH登记处（2011年12月至2019年12月）的数据。纳入确诊为aSAH且在发病后72小时内记录了WBC和PC的患者。采用单因素和多因素回归模型，其既定预测指标包括改良Fisher分级（mFS）和世界神经外科医师联合会分级（WFNS）。使用AUC（95%CI）和C统计量评估预测价值。
在954例接受评估的患者中，660例符合纳入标准，其中178例（27.0%）发生了DCI。发生DCI的患者入院时WBC水平显著更高（均值（标准差）14.3（5.1）×10⁹/L vs. 12.7（4.8）×10⁹/L，p<0.001），而入院时PC无显著差异（中位数（四分位间距）255（201-301）×10⁹/L vs. 241（205-289）×10⁹/L，p=0.196）。WBC可预测DCI（OR 1.06，1.03-1.10），但PC不能（OR 1.
