In Reply: White Blood Cell Count Improves Prediction of Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
| Autor: | Sachin Agarwal, Soojin Park, E. Sander Connolly, J. Michael Schmidt, Jan Claassen, David Roh, Fawaz Al-Mufti, Philip M. Meyers, Aws Alawi, Kalina Anna Misiolek, Andrew Bauerschmidt |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Subarachnoid hemorrhage Gastroenterology Brain Ischemia Leukocyte Count 03 medical and health sciences 0302 clinical medicine Internal medicine White blood cell medicine Humans Prospective cohort study medicine.diagnostic_test business.industry Cerebral infarction Hazard ratio Area under the curve Complete blood count Cerebral Infarction Odds ratio Subarachnoid Hemorrhage medicine.disease medicine.anatomical_structure 030220 oncology & carcinogenesis Surgery Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery. 86:E579-E579 |
| ISSN: | 1524-4040 0148-396X |
| Popis: | BACKGROUND Immune dysregulation has long been implicated in the development of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To determine the relationship of inflammatory cell biomarkers with DCI. METHODS We evaluated 849 aSAH patients who were enrolled into a prospective observational cohort study and had a white blood cell (WBC) differential obtained within 72 h of bleed onset. RESULTS WBC count > 12.1 × 109/L (odds ratio 4.6; 95% confidence interval [CI]: 1.9-11, P < 0.001) was the strongest Complete Blood Count (CBC) predictor of DCI after controlling for clinical grade (P < .001), thickness of SAH blood on admission computed tomography (P = .002), and clipping aneurysm repair (P < .001). A significant interaction between clinical grade and WBC count (odds ratio 0.8, 95% CI: 0.6-1.0, P = .02) revealed that good-grade patients with elevated WBC counts (49%: 273/558) had increased odds for DCI indistinguishable from poor-grade patients. Multivariable Cox regression also showed that elevated WBC counts in good-grade patients increased the hazard for DCI to that of poor-grade patients (hazard ratio 2.1, 95% CI 1.3-3.2, P < .001). Receiver operating characteristic curve analysis of good-grade patients revealed that WBC count (area under the curve [AUC]: 0.63) is a stronger DCI predictor than the modified Fisher score (AUC: 0.57) and significantly improves multivariable DCI prediction models (Z = 2.0, P = .02, AUC: 0.73; PPV: 34%; NPV: 92%). CONCLUSION Good-grade patients with early elevations in WBC count have a similar risk and hazard for DCI as poor-grade patients. Good-grade patients without elevated WBC may be candidates to be safely downgraded from the intensive care unit, leading to cost savings for both patient families and hospitals. |
| Databáze: | OpenAIRE |
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