White Blood Cell Count Improves Prediction of Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage

Al‐Mufti, Fawaz; Misiolek, Kalina Anna; Roh, David; Alawi, Aws; Bauerschmidt, Andrew; Park, Soo‐Jin; Agarwal, Sachin; Meyers, Philip M.; Connolly, E. Sander; Claassen, Jan; Schmidt, J. Michael

doi:10.1093/neuros/nyy045

Cited by 65 publications

(38 citation statements)

References 36 publications

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“…Collected data included patient characteristics on admission and during treatment course, radiological features, and clinical outcomes. SAH and the radiological severity were evaluated using the WFNS grading scale (15) and Fisher score, respectively. The incidence of cerebral vasospasm, acute hydrocephalus, and delayed cerebral ischemia (DCI) were also obtained for each patient.…”

Section: Methodsmentioning

confidence: 99%

C-Reactive Protein/Albumin Ratio Correlates With Disease Severity and Predicts Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage

et al. 2019

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Aim: The purpose of the present study was to determine if C-reactive protein (CRP)/albumin ratio was associated with disease severity and unfavorable outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).Methods: One hundred and twenty-three consecutive patients suffering from aSAH were included in the study, which was carried out during the period of June 2016 to September 2018. Clinical and demographic parameters were recorded. CRP and albumin assessments were conducted upon admission. The association of CRP/albumin ratio with the disease severity and 3-month outcomes was evaluated.Results: Higher CRP/albumin ratio was significantly associated with a higher World Federation of Neurological Surgeons Scale (WFNS) grade (p < 0.05). Poor outcome at 3 months was associated with a higher WFNS grade, higher serum glucose, higher CRP level, lower albumin level, higher Fisher score, higher CRP/albumin ratio, symptomatic cerebral vasospasm, intraventricular hemorrhage, delayed cerebral ischemia, and age using univariate analysis. The multivariate binary regression analysis revealed that the CRP/albumin ratio was independently associated with unfavorable outcomes after adjustment for age, WFNS grade, serum glucose, albumin, Fisher score, symptomatic cerebral vasospasm, intraventricular hemorrhage, and delayed cerebral ischemia.Conclusion: Elevated CRP/albumin ratio was associated with disease severity and poor outcomes after aSAH.

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Section: Methodsmentioning

confidence: 99%

C-Reactive Protein/Albumin Ratio Correlates With Disease Severity and Predicts Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage

et al. 2019

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“…Unlike ICH, there are abundant prospective human data in SAH to suggest elevated circulating leukocyte is associated with poor outcome and SAH complications [97][98][99][100][101] (Table 3). Across studies, early increase in blood leucocytes predicted delayed cerebral ischemia (DCI) and poor SAH outcome, while its association with cerebral vasospasm was inconsistent.…”

Section: Peripheral Immune Cells and Hemorrhagic Strokementioning

confidence: 99%

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

Saand

Chen

et al. 2019

J Cereb Blood Flow Metab

124

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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“…5,[28][29][30][31][32] aSAH can induce the leukocytosis and increased neutrophils by stimulating the systemic cellular responses that can cause the brain injury and delayed cerebral ischemia. 33,34 Early studies showed that the growth and rupture of cerebral aneurysms were promoted via the leukocyte infiltration and inflammatory reaction in the wall of aneurysms. [35][36][37][38] The results of histopathology found that the thinned wall of aneurysms was related to leukocytosis.…”

Section: F I G U R E 2 Roc Curve Of the Prognosis In Patients With Aashmentioning

confidence: 99%

Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage

Zhang

et al. 2020

Clinical Laboratory Analysis

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Aneurysmal subarachnoid hemorrhage (aSAH) is an acute cerebrovascular disease that seriously damages the central nervous system and simultaneously exerts pathophysiological effects on multiple organs of the body, with high mortality and morbidity. 1,2 Approximately onethird of the survivors suffer from severe disability and functional dependency. 3 Rebleeding is a major early complication of aSAH with the incidence of 6%-23%, which most occurs within 72 hours of onset. 4,5 Previous studies reported that the mortality was 50%-60% in the presence of rebleeding. 4-6 To date, craniotomy clipping and endovascular embolization serve as main treatments for aSAH to prevent and treat complications such as rebleeding, vasospasm and hydrocephalus, and to reduce the occurrences of deaths and disabilities. 7-11 Although improvements in intensive care and treatments in recent years, the prognosis is still a frequent concern for aSAH. To the best of our knowledge,

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White Blood Cell Count Improves Prediction of Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage

Cited by 65 publications

References 36 publications

C-Reactive Protein/Albumin Ratio Correlates With Disease Severity and Predicts Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage

C-Reactive Protein/Albumin Ratio Correlates With Disease Severity and Predicts Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage

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

Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage

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