Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage.
Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage.
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DOI：
10.3389/fneur.2021.694996
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发表时间：
2021
影响因子：
3.4
通讯作者：
Choi HA
中科院分区：
文献类型：
--
作者：
Gusdon AM;Savarraj JPJ;Shihabeddin E;Paz A;Assing A;Ko SB;McCullough LD;Choi HA
目的：蛛网膜下腔出血（SAH）后的全身炎症与迟发性脑缺血（DCI）和不良临床结局有关。我们假设外周血白细胞的早期变化与SAH后的结局相关。研究方法：2009年1月至2016年12月期间入院的SAH患者入组了一项前瞻性观察性研究，并在入院时评估了Hunt Hess量表（HHS），在出院时评估了DCI和改良分级量表（mRS）。在入院当天（第0天）至出血后8天（第8天）测定总白色血细胞（WBC）计数和细胞分类计数的各组分。入院CT评估全脑水肿（GCE），并确定是否存在任何感染。统计学检验包括学生t检验、卡方检验和多变量逻辑回归（MLR）模型。结果：共分析了451例受试者。总WBC和中性粒细胞最初下降，在SAH后第4-5天达到最低值。SAH后单核细胞计数逐渐增加，在第6-8天达到峰值，而嗜碱性粒细胞和淋巴细胞最初从0天到1天下降，此后稳步增加。中性粒细胞与淋巴细胞比率（NLR）在第1天达到峰值，此后下降。WBC、中性粒细胞、单核细胞和NLR在DCI和功能结局差的患者中较高。发生感染的受试者的WBC、中性粒细胞和NLR较高。在MLR模型中，中性粒细胞和单核细胞与DCI和更差的功能结局相关，而NLR仅与更差的功能结局相关。感染的发生与不良结局相关。中性粒细胞和NLR与感染相关，而单核细胞则与感染无关。单核细胞在男性中较高，ROC曲线分析显示单核细胞预测男性受试者DCI和不良功能结局的能力提高。结论：单核细胞增多与蛛网膜下腔出血后DCI和不良功能结局相关。中性粒细胞和NLR与感染之间的关联可能会影响结果。单核细胞早期升高可提高预测男性DCI和不良功能结局的能力，这与感染的发生无关。
Objective: Systemic inflammation after subarachnoid hemorrhage (SAH) is implicated in delayed cerebral ischemia (DCI) and adverse clinical outcomes. We hypothesize that early changes in peripheral leukocytes will be associated with outcomes after SAH. Methods: SAH patients admitted between January 2009 and December 2016 were enrolled into a prospective observational study and were assessed for Hunt Hess Scale (HHS) at admission, DCI, and modified Ranked Scale (mRS) at discharge. Total white blood cell (WBC) counts and each component of the differential cell count were determined on the day of admission (day 0) to 8 days after bleed (day 8). Global cerebral edema (GCE) was assessed on admission CT, and presence of any infection was determined. Statistical tests included student's t-test, Chi-square test, and multivariate logistic regression (MLR) models. Results: A total of 451 subjects were analyzed. Total WBCs and neutrophils decreased initially reaching a minimum at day 4–5 after SAH. Monocyte count increased gradually after SAH and peaked between day 6–8, while basophils and lymphocytes decreased initially from day 0 to 1 and steadily increased thereafter. Neutrophil to lymphocyte ratio (NLR) reached a peak on day 1 and decreased thereafter. WBCs, neutrophils, monocytes, and NLR were higher in patients with DCI and poor functional outcomes. WBCs, neutrophils, and NLR were higher in subjects who developed infections. In MLR models, neutrophils and monocytes were associated with DCI and worse functional outcomes, while NLR was only associated with worse functional outcomes. Occurrence of infection was associated with poor outcome. Neutrophils and NLR were associated with infection, while monocytes were not. Monocytes were higher in males, and ROC curve analysis revealed improved ability of monocytes to predict DCI and poor functional outcomes in male subjects. Conclusions: Monocytosis was associated with DCI and poor functional outcomes after SAH. The association between neutrophils and NLR and infection may impact outcomes. Early elevation in monocytes had an improved ability to predict DCI and poor functional outcomes in males, which was independent of the occurrence of infection.
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影响因子：
82.9
作者：
Benakis C;Brea D;Caballero S;Faraco G;Moore J;Murphy M;Sita G;Racchumi G;Ling L;Pamer EG;Iadecola C;Anrather J
通讯作者：
Anrather J
影响因子：
3.4
作者：
Bacigaluppi S;Ivaldi F;Bragazzi NL;Benvenuto F;Gallo F;D'Andrea A;Severi P;Uccelli A;Zona G
通讯作者：
Zona G
影响因子：
2.8
作者：
Akpek, Mahmut;Kaya, Mehmet Gungor;Gibson, Charles Michael
通讯作者：
Gibson, Charles Michael
影响因子：
8.3
作者：
Claassen, J;Carhuapoma, JR;Mayer, SA
通讯作者：
Mayer, SA
影响因子：
5.6
作者：
Gao L;Lu Q;Huang LJ;Ruan LH;Yang JJ;Huang WL;ZhuGe WS;Zhang YL;Fu B;Jin KL;ZhuGe QC
通讯作者：
ZhuGe QC