Monocyte-based inflammatory indices predict outcomes following aneurysmal subarachnoid hemorrhage

Feghali, James; Kim, Jennifer; Gami, Abhishek; Rapaport, Sarah; Caplan, Justin M.; McDougall, Cameron G.; Huang, Judy; Tamargo, Rafael J.; Jackson, Christopher M.

doi:10.1007/s10143-021-01525-1

Cited by 26 publications

(23 citation statements)

References 49 publications

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“…Regarding clinical implications, our preliminary data have shown that monocyte count on admission predicts shunt dependence after aSAH. Moreover, prior studies have shown an association between monocyte counts on admission or monocyte-based inflammatory indices with unfavorable functional outcomes and cerebral infarction ( 23 , 24 ). Feghali et al ( 23 ) showed that the monocyte-neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio, but not the neutrophil-to-lymphocyte ratio, to be independently associated with unfavorable functional outcomes (mRS of 3–6) at 12–18 months following discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, prior studies have shown an association between monocyte counts on admission or monocyte-based inflammatory indices with unfavorable functional outcomes and cerebral infarction ( 23 , 24 ). Feghali et al ( 23 ) showed that the monocyte-neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio, but not the neutrophil-to-lymphocyte ratio, to be independently associated with unfavorable functional outcomes (mRS of 3–6) at 12–18 months following discharge. Moreover, the authors reported the lymphocyte-to-monocyte ratio to be significantly associated with vasospasm ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…Feghali et al ( 23 ) showed that the monocyte-neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio, but not the neutrophil-to-lymphocyte ratio, to be independently associated with unfavorable functional outcomes (mRS of 3–6) at 12–18 months following discharge. Moreover, the authors reported the lymphocyte-to-monocyte ratio to be significantly associated with vasospasm ( 23 ). Unda et al ( 24 ) found a relationship between monocyte count on admission with cerebral infarction and unfavorable functional outcomes (mRS of 3–6) at 12 months after discharge.…”

Section: Discussionmentioning

confidence: 99%

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Monocyte Count on Admission Is Predictive of Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage

et al. 2022

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The authors sought to evaluate whether immunologic counts on admission were associated with shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage. A retrospective analysis of 143 consecutive patients with aneurysmal subarachnoid hemorrhage over a 9-year period was performed. A stepwise algorithm was followed for external ventricular drain weaning and determining the necessity of shunt placement. Data were compared between patients with and without shunt-dependent hydrocephalus. Overall, 11.19% of the cohort developed shunt-dependent hydrocephalus. On multivariate logistic regression analysis, acute hydrocephalus (OR: 61.027, 95% CI: 3.890–957.327; p = 0.003) and monocyte count on admission (OR: 3.362, 95% CI: 1.024–11.037; p = 0.046) were found to be independent predictors for shunt dependence. Receiver operating characteristic curve analysis for the prediction of shunt-dependent hydrocephalus confirmed that monocyte count exhibited an acceptable area under the curve (AUC = 0.737, 95% CI: 0.601–0.872; p < 0.001). The best predictive cutoff value to discriminate between successful external ventricular drain weaning and shunt-dependent hydrocephalus was identified as a monocyte count ≥0.80 × 103/uL at initial presentation. These preliminary data demonstrate that a monocyte count ≥0.80 × 103/uL at admission predicts shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage; however, further large-scale prospective trials and validation are necessary to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Monocyte Count on Admission Is Predictive of Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage

et al. 2022

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“…A prospective study [ 10 ] demonstrated an increased monocyte infiltration secondary to aneurysm rupture in patients with DCI. Moreover, early brain injury (EBI) is the direct brain lesion resulting from the initial bleeding in the acute stage of an SAH, which occurs within the first 3 days after an SAH and is one of the primary causes of the poor prognosis after an SAH [ 11 , 12 , 13 ]. Inflammatory responses following an SAH, an important pathological process in EBI, include the activation of resident microglia and subsequent infiltration of peripheral monocytes [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Exploration of Risk Factors for Poor Prognosis of Non-Traumatic Non-Aneurysmal Subarachnoid Hemorrhage

et al. 2022

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Background: Subarachnoid hemorrhage (SAH) is a devastating neurological disease associated with high rates of mortality and disability. Aneurysms are the main cause of non-traumatic subarachnoid hemorrhages. However, non-traumatic non-aneurysmal subarachnoid hemorrhage (naSAH), another clinical type of SAH, has been poorly studied for its prognosis and risk factors. Method and result: We collected demographic and clinical variables for 126 naSAH and 89 aneurysmal subarachnoid hemorrhage (aSAH) patients, including age and gender; hospitalization days; hematological indicators; clinical score scales; past medical history; and personal history. We found that the monocytes in naSAH (0.50 ± 0.26) patients were lower than in aSAH patients (0.60 ± 0.27). The prevalence of diabetes in naSAH (30.2%) patients was higher than in aSAH (14.5%) patients. The naSAH patients were divided into good and poor outcome groups based on the modified Rankin Scale at the 90th day (90-day mRS) after discharge. A univariate analysis showed that there were significant differences in age, white blood cell count (WBC), monocyte count, D-dipolymer, neuron-specific enolase (NSE), random blood glucose (RBG), aspartate transaminase (AST), urea and free triiodothyronine (FT3) between the two groups. A logistic regression showed that aging and high level NSE were independent risk factors for a poor outcome. The predictive ability of age (area under curve (AUC) = 0.71) and NSE (AUC = 0.68) were analyzed by a receiver operating characteristic (ROC) curve. The results of the logistic regression suggested that age, D-dipolymer, NSE, RBG, urea and FT3 distinguished and predicted the prognosis of naSAH. The discriminant analysis of the above variables revealed that the discriminant accuracy was 80.20%. Conclusions: Compared with aSAHs, naSAHs are more likely to occur in patients with diabetes, and the level of monocytes is lower. Moreover, the prognosis of elderly patients with an naSAH is relatively poor, and the level of NSE in the course of the disease also reflects the prognosis. Multivariate comprehensive analysis is helpful to judge the prognosis of patients at a small cost.

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“…Recent studies have confirmed that inflammation in the initial phase of aSAH is implicated in its pathological process (6). Several peripheral inflammatory markers, including the neutrophil-toalbumin ratio (NAR) (7), neutrophil-to-lymphocyte ratio (NLR) (8), platelet-to-lymphocyte ratio (PLR) (9), monocyte-to-lymphocyte ratio (MLR) (10), and systemic immune inflammation index (SII) (11), have been reported to be associated with short-term outcomes of aSAH, raising the possibility that they may serve as promising prognosticators. However, there has yet to be a systematic study on whether these markers can improve the predictive capabilities of existing models.…”

Section: Introductionmentioning

confidence: 95%

Improving the models for prognosis of aneurysmal subarachnoid hemorrhage with the neutrophil-to-albumin ratio

et al. 2023

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ObjectiveMany peripheral inflammatory markers were reported to be associated with the prognosis of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to identify the most promising inflammatory factor that can improve existing predictive models.MethodsThe study was based on data from a 10 year retrospective cohort study at Sichuan University West China Hospital. We selected the well-known SAFIRE and Subarachnoid Hemorrhage International Trialists’ (SAHIT) models as the basic models. We compared the performance of the models after including the inflammatory markers and that of the original models. The developed models were internally and temporally validated.ResultsA total of 3,173 patients were included in this study, divided into the derivation cohort (n = 2,525) and the validation cohort (n = 648). Most inflammatory markers could improve the SAH model for mortality prediction in patients with aSAH, and the neutrophil-to-albumin ratio (NAR) performed best among all the included inflammatory markers. By incorporating NAR, the modified SAFIRE and SAHIT models improved the area under the receiver operator characteristics curve (SAFIRE+NAR vs. SAFIRE: 0.794 vs. 0.778, p = 0.012; SAHIT+NAR vs. SAHIT: 0.831 vs. 0.819, p = 0.016) and categorical net reclassification improvement (SAFIRE+NAR: 0.0727, p = 0.002; SAHIT+NAR: 0.0810, p < 0.001).ConclusionThis study illustrated that among the inflammatory markers associated with aSAH prognosis, NAR could improve the SAFIRE and SAHIT models for 3 month mortality of aSAH.

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Monocyte-based inflammatory indices predict outcomes following aneurysmal subarachnoid hemorrhage

Cited by 26 publications

References 49 publications

Monocyte Count on Admission Is Predictive of Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage

Monocyte Count on Admission Is Predictive of Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage

Exploration of Risk Factors for Poor Prognosis of Non-Traumatic Non-Aneurysmal Subarachnoid Hemorrhage

Improving the models for prognosis of aneurysmal subarachnoid hemorrhage with the neutrophil-to-albumin ratio

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