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

Abstract

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.

Systemic innate myeloid responses to acute ischaemic and haemorrhagic stroke

“…In ICH, studies have previously described an association between high monocyte counts on admission with mortality and poor outcome [112,166]. Latent monocyte infiltration of the CSF in aneurysmal SAH patients has been related to DCI [76], whereas elevated levels of peripheral blood monocytes at admission have been related to vasospasm and hydrocephalus [113,167]. Therefore, clinical findings consistently support a role for monocytes in both primary and secondary brain injury.…”

Editorial: Update on Multidisciplinary Management of Surgical Neurovascular Pathologies

“…In the article “ The different fates of three aneurysms: Diagnosis and treatment strategies for unruptured intracranial aneurysms with other intracranial diseases ” ( 5 ), Dr. Gaochao Guo and co-workers analyzed the possible treatment strategies for intracranial aneurysms complicated by other diseases in three different clinical scenarios. Lastly, in their interesting manuscript “ Monocyte count on admission is predictive of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage ” ( 6 ), Dr. Cuoco and colleagues interestingly found that monocyte count ≥0.80 × 103/uL at admission predicts shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage.…”