Hematologic counts as predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Silva, Ivan Rocha Ferreira da; Gomes, João; Wachsman, Ari; Freitas, Gabriel R. de; Provencio, J. Javier

doi:10.1016/j.jcrc.2016.09.011

Cited by 24 publications

(6 citation statements)

References 53 publications

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“…This study builds upon results from prior studies, which have demonstrated the role of peripheral leukocytes after SAH. While several important studies have shown that WBC count has an association with DCI ( 62 , 63 ), herein we have provided a comprehensive assessment of the role of differential cell counts on DCI and functional outcomes. Our assessments of the role of sex differences and associations with infection have also not been addressed in prior studies.…”

Section: Discussionmentioning

confidence: 99%

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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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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Section: Discussionmentioning

confidence: 99%

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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“…Delayed cerebral ischemia is one of the major complications of aSAH and one of the leading causes of high morbidity and mortality. Early diagnosis and management of vasospasm following aSAH is an important step to improve the prognosis [9] . The aim of this work was to assess the value of EEG monitoring and TCD as early biomarkers of vasospasm following aSAH and the value of early intervention to avoid the consequences of DCI.…”

Section: Discussionmentioning

confidence: 99%

Vasospasm following aneurysmal subarachnoid hemorrhage: prediction, detection, and intervention

Nassar

Ghali

Bahnasy

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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BackgroundVasospasm of the cerebral blood vessels is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) which results in delayed cerebral ischemia (DCI) and worsening of the outcome.MethodsThis study was performed on 41 aSAH patients diagnosed by non-contrast brain CT, CT angiography, and digital subtraction angiography followed by interventional aneurysmal embolization. Patients were followed up for 20 days by clinical assessment, EEG monitoring, and transcranial duplex studies (TCD) for early detection of vasospasm and DCI.ResultsThe most common ruptured aneurysmal sites were middle cerebral, anterior communicating, posterior communicating, terminal internal carotid, and anterior cerebral arteries respectively. The incidence of vasospasm was 36.8% of the included cases; 57% progressed to DCI while 43% passed a spontaneous regressive course. The most common arteries undergoing vasospasm were the MCA followed by the ACA, ICA, and lastly the basilar arteries. The mean time of vasospasm development as detected by EEG monitoring and/or TCD was 8.4 ± 2.8 days which was earlier than clinical signs by 12.5 ± 5.3 h in those progressed to DCI.ConclusionContinuous EEG monitoring and TCD are valuable methods for early detection of vasospasm and they allow for early therapeutic intervention before irreversible ischemic neurological deficits take place.

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“…McGirt et al 134 224 cases, Retrospective 1-5 days post SAH Serum leukocyte count greater than 15 Â 10 9 /L was independently associated with vasospasm. Da Silva et al 220 55 cases, Retrospective 32 30 cases, Prospective 6 h -7 days after IS onset Neutrophil count was negatively associated with spleen volume change. Leukocyte count did not predict outcome.…”

Section: Peripheral Immune Cells and Hemorrhagic Strokementioning

confidence: 97%

Systemic inflammation in hemorrhagic strokes – A novel neurological sign and therapeutic target?

Saand

Chen

et al. 2019

J Cereb Blood Flow Metab

131

132

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Growing evidences suggest that stroke is a systemic disease affecting many organ systems beyond the brain. Stroke-related systemic inflammatory response and immune dysregulations may play an important role in brain injury, recovery, and stroke outcome. The two main phenomena in stroke-related peripheral immune dysregulations are systemic inflammation and post-stroke immunosuppression. There is emerging evidence suggesting that the spleen contracts following ischemic stroke, activates peripheral immune response and this may further potentiate brain injury. Whether similar brain–immune crosstalk occurs in hemorrhagic strokes such as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) is not established. In this review, we systematically examined animal and human evidence to date on peripheral immune responses associated with hemorrhagic strokes. Specifically, we reviewed the impact of clinical systemic inflammatory response syndrome (SIRS), inflammation- and immune-associated biomarkers, the brain–spleen interaction, and cellular mediators of peripheral immune responses to ICH and SAH including regulatory T cells (Tregs). While there is growing data suggesting that peripheral immune dysregulation following hemorrhagic strokes may be important in brain injury pathogenesis and outcome, details of this brain-immune system cross-talk remain insufficiently understood. This is an important unmet scientific need that may lead to novel therapeutic strategies in this highly morbid condition.

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Hematologic counts as predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Cited by 24 publications

References 53 publications

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Vasospasm following aneurysmal subarachnoid hemorrhage: prediction, detection, and intervention

Systemic inflammation in hemorrhagic strokes – A novel neurological sign and therapeutic target?

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