Association of Platelet and Leukocyte Counts with Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose: A proinflammatory prothrombotic state may increase the risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). We studied the relationship of levels of leukocytes, platelets, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with the development of DCI and with clinical outcome in patients with aneurysmal SAH. Methods: In 125 patients admitted within 72 h after aneurysmal SAH, we dichotomized initial blood levels at their median values and investigated the prediction of DCI with Cox proportional hazard analysis and of poor clinical outcome with logistic regression analysis. We also analyzed concentrations before and after onset of DCI with the paired-samples t test and compared changes with those in patients without DCI. Results: During the development of DCI (unrelated to treatment), patients had a larger increase in counts of platelets (difference 49 × 10⁹/l; 95% CI: 2–98) and leukocytes (difference 2.6 × 10⁹/l; 95% CI: 0.4–5.0) than patients without DCI during the same period. CRP increased during DCI and decreased in patients without DCI (difference 14 mg/l; 95% CI: –29 to 58). ESR increased slightly in both groups (difference 3 mm/h; 95% CI: –15 to 20). None of the determinants at baseline predicted the development of DCI. An increased risk of poor outcome predicted by a high initial leukocyte count (OR 2.5; 95% CI: 1.1–5.7) decreased after adjustment for clinical variables (OR 2.1; 95% CI: 0.8–5.5). Conclusion: Counts of platelets and leukocytes disproportionally increase during the occurrence of DCI after aneurysmal SAH. Drugs with anti-thrombotic or anti-inflammatory properties should be studied for prevention and treatment of DCI.

Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage based on the analysis of on-admission information

“…No relationship has been revealed between WBC count and rebleeding previous to our study, although high level of leukocyte count was reported to be associated with an increased risk of delayed cerebral ischemia after aSAH (15). It has also been shown that in mice, leukocytes and platelets adhere the microvasculature at the cerebral surface immediately after SAH.This may rapidly cause a whole-brain injury due to early inflammatory and prothrombogenic responses (12).…”

Relation of Serum TNF-α and TNF-α Genotype with Delayed Cerebral Ischemia and Outcome in Subarachnoid Hemorrhage

“…Other parameters of systemic inflammation like CRP en leukocytes may be more valuable predictors for DCI and poor outcome after SAH. One study found an increase in both CRP and leukocyte counts during the development of DCI which were significantly larger than in patients without DCI at the same period after onset of aneurysmal SAH, although neither CRP or leukocyte counts were found to be independent prognostic markers for the development of DCI or poor outcome [19]. Other studies also found an increase in leukocyte counts before or at the time of clinical manifestation of DCI [20,21].…”

Microglia inflict delayed brain injury after subarachnoid hemorrhage

“…Although systemic inflammatory reactions after SAH have been described earlier [18,35], the concept of…”