The value of white blood cell count and platelet count in predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine Pub Date : 2025-01-01 DOI:10.1016/j.bas.2025.104236

Eva Postma , Homeyra Labib , Jordi van Lange , Bert Coert , René Post , René van den Berg , Charles Majoie , W. Peter Vandertop , Dagmar Verbaan

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Abstract

Introduction

Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) contributes significantly to mortality and morbidity. Neuroinflammation and platelet activation are implicated in its pathophysiology.

Research question

This study evaluates the association of admission white blood cell count (WBC) and platelet count (PC), and their combination, with DCI and explores their integration into predictive models.

Materials and methods

This single-center cohort study utilized data from a prospective SAH registry (December 2011–December 2019). Patients with confirmed aSAH and recorded WBC and PC within 72 h post-ictus were included. Univariate and multivariate regression models with established predictors, consisting of the modified Fisher scale (mFS) and World Federation of Neurological Surgeons grade (WFNS), were performed. Predictive values were assessed using AUCs (95 % CI) and C-statistics.

Results

Of 954 reviewed patients, 660 met inclusion criteria, with 178 (27.0 %) developing DCI. Patients who developed DCI had significantly higher admission WBC levels (mean (SD) 14.3 (5.1) × 10⁹/L vs. 12.7 (4.8) × 10⁹/L, p < 0.001), whereas admission PC did not differ significantly (median (IQR) 255 (201–301) × 10⁹/L vs. 241 (205–289) × 10⁹/L, p = 0.196). WBC was predictive of DCI (OR 1.06, 1.03–1.10), but PC was not (OR 1.00, 1.00–1.02). Of established predictors, mFS was significant (OR 6.42, 1.96–21.02), whereas WFNS was not (OR 0.79, 0.54–1.15). Among all variables, WBC demonstrated highest predictive value (AUC: 0.59, 0.54–0.64), surpassing mFS and WFNS, or their combination. A combined model incorporating WBC, PC, mFS, and WFNS yielded the highest predictive value (AUC: 0.63, 0.58–0.68).

Discussion and conclusion

Admission WBC and PC offer modest predictive value for DCI, either alone or combined with neurological status and hemorrhage burden. However, WBC demonstrated highest predictive value of all investigated variables and modestly improves prediction models. Future research should evaluate WBC’s utility in models with enhanced predictive performance.

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白细胞计数和血小板计数对动脉瘤性蛛网膜下腔出血后迟发性脑缺血的预测价值

动脉瘤性蛛网膜下腔出血（aSAH）后迟发性脑缺血（DCI）对死亡率和发病率有重要影响。神经炎症和血小板活化参与其病理生理。研究问题本研究评估入院白细胞计数（WBC）和血小板计数（PC）及其组合与DCI的关系，并探索将它们整合到预测模型中。材料和方法本单中心队列研究使用了前瞻性SAH登记（2011年12月- 2019年12月）的数据。患者确诊aSAH，并记录WBC和PC后72h。采用修正Fisher量表（mFS）和世界神经外科医师联合会评分（WFNS），建立单因素和多因素回归模型。使用auc （95% CI）和C-statistics评估预测值。结果954例患者中，660例符合纳入标准，178例（27.0%）发展为DCI。发生DCI的患者入院时白细胞水平明显较高(平均（SD） 14.3 （5.1） × 109/L vs 12.7 （4.8） × 109/L, p <；而入院PC无显著差异（中位（IQR） 255 （201-301） × 109/L vs. 241 （205-289） × 109/L, p = 0.196）。WBC可预测DCI (OR 1.06, 1.03-1.10)，而PC不能预测DCI （OR 1.00, 1.00 - 1.02）。在已建立的预测因子中，mFS具有显著性（OR为6.42,1.96-21.02），而WFNS无显著性（OR为0.79,0.54-1.15）。在所有变量中，WBC表现出最高的预测价值（AUC: 0.59, 0.54-0.64），超过mFS和WFNS，或它们的组合。合并WBC、PC、mFS和WFNS的联合模型的预测值最高（AUC: 0.63, 0.58-0.68）。讨论与结论入院WBC和PC单独或联合神经系统状况和出血负担对DCI有一定的预测价值。然而，白细胞在所有研究变量中显示出最高的预测价值，并适度改善了预测模型。未来的研究应该评估WBC在预测性能增强的模型中的效用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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