Impact of Early Leukocytosis and Elevated High-Sensitivity C-Reactive Protein on Delayed Cerebral Ischemia and Neurologic Outcome After Subarachnoid Hemorrhage
Impact of Early Leukocytosis and Elevated High-Sensitivity C-Reactive Protein on Delayed Cerebral Ischemia and Neurologic Outcome After Subarachnoid Hemorrhage
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DOI：
10.1016/j.wneu.2016.02.049
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发表时间：
2016-06-01
影响因子：
2
通讯作者：
Dhandapani, Sivashanmugam
中科院分区：
文献类型：
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作者：
Srinivasan, Anirudh;Aggarwal, Ashish;Dhandapani, Sivashanmugam
背景：炎症反应在蛛网膜下腔出血（SAH）病理生理中的作用越来越被认识到。本研究分析了早期炎症反应的细胞和生化指标对SAH后预后的影响。方法：前瞻性研究SAH患者早期细胞、生化和细胞毒性炎症反应的标志物，包括白细胞总数（TLC）、高敏c反应蛋白（hs-CRP）和乳酸脱氢酶。研究这些指标与延迟性脑缺血（DCI）、新发梗死和3个月时格拉斯哥预后量表（GOS）评分的关系。结果：该研究纳入246例患者。在发生DCI的患者中，94例患者的TLC [+/- SD]明显较高(11.2 × 10(3)/mm(3) [+/- 4.0] vs. 9.4 × 10(3)/mm(3) [+/- 2.9], P = 0.001)， 62例新梗死患者的TLC显著较高(11.0 × 10(3)/mm(3) [+/- 3.6] vs. 9.8 × 10（3)/mm(3) [+/- 3.4], P = 0.05）。入院时GOS评分与TLC呈显著负相关。平均TLC (+ / - SD)是12.7 x 10(3) /毫米(3)(+ / - 4.2),11.7 x 10(3) /毫米(3)(+ / - 3.1),10.2 x 10(3) /毫米(3)(+ / - 3.4),和9.3 x 10(3) /毫米(3)(+ / - 2.8)患者GOS评分1,3,4,5 (P < 0.001)。单因素分析hs-CRP与GOS评分呈负相关。乳酸脱氢酶与预后指标无相关性。在多因素分析中，较高的入院TLC与DCI （P = 0.01）和较差的GOS评分显著相关（P < 0.001），较高的hs-CRP与较差的GOS评分显著相关（P = 0.05）。结论：白细胞对休克的反应似乎与DCI和GOS评分差有显著的独立关联，hs-CRP水平与GOS评分差有显著的独立关联，表明早期细胞反应在SAH病理生理中具有突出地位。
BACKGROUND: The role of inflammatory response in the pathophysiology of subarachnoid hemorrhage (SAH) is being increasingly recognized. This study analyzed the impact of cellular and biochemical markers of early inflammatory response to ictus on outcome after SAH.METHODS: Patients with SAH were prospectively studied for markers of early cellular, biochemical, and cytotoxic inflammatory response, including total leukocyte count (TLC), high-sensitivity C-reactive protein (hs-CRP), and lactate dehydrogenase. The relationship of these markers to delayed cerebral ischemia (DCI), new infarct, and Glasgow Outcome Scale (GOS) score at 3 months was studied.RESULTS: The study comprised 246 patients. Of patients, 94 who developed DCI had a significantly higher TLC [+/- SD] (11.2 3 10(3)/mm(3) [+/- 4.0] vs. 9.4 x 10(3)/mm(3) [+/- 2.9], P = 0.001) and 62 with new infarct had significantly higher TLC (11.0 X 10(3)/mm(3) [+/- 3.6] vs. 9.8 X 10(3)/mm(3) [+/- 3.4], P = 0.05). GOS score had a significant inverse relationship to TLC at admission. The mean TLC [+/- SD] was 12.7 x 10(3)/mm(3) [+/- 4.2], 11.7 x 10(3)/mm(3) [+/- 3.1], 10.2 x 10(3)/mm(3) [+/- 3.4], and 9.3 x 10(3)/mm(3) [+/- 2.8] among patients with GOS scores of 1, 3, 4, and 5 (P < 0.001). hs-CRP showed a trend of an inverse relationship to GOS score in univariate analysis. Lactate dehydrogenase had no relationship with any outcome parameter. In multivariate analysis, higher admission TLC had a significant association with DCI (P = 0.01) and poorer GOS score (P < 0.001), and higher hs-CRP had a significant association with poorer GOS score (P = 0.05).CONCLUSIONS: A leukocytosis response to ictus seems to have a significant independent association with both DCI and poor GOS score, and hs-CRP level had a significant independent association with poor GOS score, indicating preeminence of early cellular response in SAH pathophysiology.