Neutrophil Count Predicts Malignant Cerebellar Edema and Poor Outcome in Acute Basilar Artery Occlusion Receiving Endovascular Treatment: A Nationwide Registry-Based Study.
Neutrophil Count Predicts Malignant Cerebellar Edema and Poor Outcome in Acute Basilar Artery Occlusion Receiving Endovascular Treatment: A Nationwide Registry-Based Study.
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中性粒细胞计数可预测接受血管内治疗的急性基底动脉闭塞患者的恶性小脑水肿和不良结果：一项全国性注册研究
DOI：
10.3389/fimmu.2022.835915
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发表时间：
2022
影响因子：
7.3
通讯作者：
中科院分区：
文献类型：
--
作者：
已知急性基底动脉闭塞（ABAO）的结局较差，尽管进行了血管内治疗（EVT），但发病率和死亡率较高，这突出了探索限制EVT在这些患者中疗效的因素的必要性。ABAO的小脑梗死可能进展为恶性小脑水肿（MCE），这是再灌注后危及生命的并发症，通过占位效应对脑干造成继发性损伤。因此，本研究的目的是探讨MCE对长期结果的影响，并探讨EVT-ABAO患者MCE的预后因素。在国家BASILAR登记研究中，共有329例经EVT治疗的患有小脑梗死的ABO患者符合入选标准。在EVT后72小时进行的计算机断层扫描中评价是否存在由Jauss量表≥4分定义的MCE。通过logistic回归模型获得调整后的比值比和95%CI。90天改良兰金量表评分为0-3分定义为良好结局。MCE与良好结局发生率降低存在统计学相关性[校正比值比，0.35（95%CI，0.18-0.68），P=0.002]。基线国立卫生研究院卒中量表评分、侧支循环、入院时中性粒细胞计数和再通状态是MCE和90天时良好功能状态的预测因子（均P<0.05）。在所有炎症因子中，中性粒细胞计数对MCE的准确性、敏感性和特异性最高。在基线模型中加入中性粒细胞计数状态可显著提高模型对MCE的预测能力，并通过增加曲线下面积、实现净重新分类和综合辨别能力的改善而获得良好结局（均P<0.05）。中介分析表明MCE介导了中性粒细胞计数升高与功能结局恶化之间的关系（P=0.026）。MCE在EVT-ABAO预后恶化中起重要作用。ABAO患者入院时中性粒细胞计数高与MCE和不良结局相关，可进一步纳入临床决策系统并指导免疫调节治疗。
Acute basilar artery occlusion (ABAO) is known to have a poor outcome with a high rate of morbidity and mortality despite endovascular treatment (EVT), highlighting the necessities of exploring factors to limit the efficacy of EVT in these patients. Cerebellar infarctions in ABAO might progress to malignant cerebellar edema (MCE), a life-threatening complication after reperfusion, posing a secondary injury to the brainstem by mass effects. Therefore, the present research aimed to explore the impacts of MCE on a long-term outcome and investigate the prognostic factors for MCE among ABAO after EVT. In the national BASILAR registry, a total of 329 ABO patients with cerebellar infarctions treated by EVT met the inclusion criteria. The presence of MCE defined by the Jauss scale ≥4 points, was evaluated on the computed tomography performed 72 h after EVT. The adjusted odds ratio and 95% CI were obtained by logistic regression models. A favorable outcome was defined as a 90-day modified Rankin Scale score of 0–3. MCE was statistically associated with the decreased incidence of a favorable outcome [adjusted odds ratio, 0.35(95% CI, 0.18-0.68), P=0.002]. The baseline National Institutes of Health Stroke Scale score, collateral circulation, neutrophil count at admission, and recanalization status were predictors for MCE and a favorable functional status at 90 days (all P<0.05). Among all inflammatory factors, the neutrophil count achieved the highest accuracy, sensitivity, and specificity for MCE. Adding the neutrophil count status into the baseline model obviously enhanced its prediction ability for MCE and favorable outcome by increasing the area under curve and achieving both net reclassification and integrated discrimination improvement (all P<0.05). Mediation analysis indicated that MCE mediated the association between the increased neutrophil count and worse functional outcome (P=0.026). MCE acted essential roles in worsening prognosis for ABAO after EVT. A high neutrophil count at admission was linked to MCE and a poor outcome among ABAO patients, which could be further incorporated into the clinical decision-making system and guide immunomodulation therapy.
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影响因子：
5.9
作者：
Enzmann G;Kargaran S;Engelhardt B
通讯作者：
Engelhardt B
影响因子：
6.7
作者：
van der Hoeven, Erik J. R. J.;McVerry, Ferghal;Schonewille, Wouter J.
通讯作者：
Schonewille, Wouter J.
影响因子：
8.3
作者：
Cheng, Bastian;Forkert, Nils Daniel;Thomalla, Goetz
通讯作者：
Thomalla, Goetz
影响因子：
8.3
作者：
Reinhard, Matthias;Schork, Joscha;Kaube, Holger
通讯作者：
Kaube, Holger
影响因子：
4.8
作者：
Yoon, Woong;Baek, Byung Hyun;Park, Man Seok
通讯作者：
Park, Man Seok