White Blood Cell Count Improves Prediction of Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
| Autor: | Fawaz Al-Mufti, Kalina Anna Misiolek, David Roh, Aws Alawi, Andrew Bauerschmidt, Soojin Park, Sachin Agarwal, Philip M Meyers, E Sander Connolly, Jan Claassen, J Michael Schmidt |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine Cerebral Infarction Middle Aged Subarachnoid Hemorrhage Cohort Studies Leukocyte Count 03 medical and health sciences 030104 developmental biology 0302 clinical medicine ROC Curve Area Under Curve Humans Female Surgery Prospective Studies Neurology (clinical) Tomography X-Ray Computed Biomarkers 030217 neurology & neurosurgery Aged |
| Zdroj: | Neurosurgery. 84:397-403 |
| ISSN: | 1524-4040 0148-396X |
| Popis: | Immune dysregulation has long been implicated in the development of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH).To determine the relationship of inflammatory cell biomarkers with DCI.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.WBC count12.1 × 109/L (odds ratio 4.6; 95% confidence interval [CI]: 1.9-11, P0.001) 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%).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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