Monocyte Count and Systemic Immune-Inflammation Index Score as Predictors of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

Abstract

Objectives&nbsp; _x000D_ <br>Delayed&nbsp;cerebral&nbsp;ischemia&nbsp;(DCI)&nbsp;is&nbsp;a&nbsp;major&nbsp;cause&nbsp;of&nbsp;disability&nbsp;in&nbsp;patients&nbsp;who&nbsp;survive&nbsp;aneurysmal&nbsp; subarachnoid&nbsp; hemorrhage&nbsp; (aSAH).&nbsp; Systemic&nbsp; inflammatory&nbsp;markers,&nbsp; such&nbsp; as&nbsp; peripheral&nbsp; leukocyte&nbsp; count&nbsp;and&nbsp;systemic&nbsp;inflammatory&nbsp;index&nbsp;score,&nbsp;have&nbsp;been&nbsp;considered&nbsp;predictors&nbsp;of&nbsp;DCI&nbsp;in&nbsp;previous&nbsp; studies.&nbsp;This&nbsp;study&nbsp;aims&nbsp;to&nbsp;investigate&nbsp;which&nbsp;systemic&nbsp;biomarkers&nbsp;are&nbsp;significant&nbsp;predictors&nbsp;of&nbsp;DCI.&nbsp;_x000D_ <br>_x000D_ <br>Methods&nbsp;_x000D_ <br>We&nbsp;conducted&nbsp;a&nbsp;retrospective,&nbsp;observational,&nbsp;signle-center&nbsp;study&nbsp;of&nbsp;170&nbsp;patients&nbsp;with&nbsp;SAH&nbsp;admitted&nbsp; We&nbsp;analyzed&nbsp; &nbsp;3 4&nbsp;and&nbsp;5 7&nbsp;days&nbsp;after&nbsp;admission.&nbsp;The&nbsp;DCI&nbsp;and&nbsp;non-DCI&nbsp;group were&nbsp;compared.&nbsp; Variables&nbsp; showing&nbsp; statistical&nbsp; significance&nbsp; in&nbsp; &nbsp; (P&nbsp; &lt;&nbsp; 0.05)&nbsp; were&nbsp; entered&nbsp;into&nbsp;a&nbsp;multivariable&nbsp;regression&nbsp;model.&nbsp; _x000D_ <br>_x000D_ <br>Results&nbsp; _x000D_ <br>hydrocephalus,&nbsp;intraventricular&nbsp;hemorrhage,&nbsp;and&nbsp;infection&nbsp;showed&nbsp;statistical&nbsp;significance&nbsp;(P&nbsp;&lt;&nbsp;0.05)&nbsp; on&nbsp; a&nbsp; univariable&nbsp; logistic&nbsp; regression.&nbsp; Lymphocyte&nbsp; and&nbsp; monocyte&nbsp; count systemic&nbsp; inflammatory&nbsp;index&nbsp;scores&nbsp;and&nbsp;C-reactive&nbsp;protein&nbsp;levels&nbsp;on&nbsp;days&nbsp;3 4,&nbsp;and&nbsp;leukocyte&nbsp; neutrophil&nbsp; counts&nbsp; on&nbsp; days&nbsp; 5 7&nbsp; exhibited&nbsp; statistical&nbsp; significance&nbsp; on&nbsp; the&nbsp; univariable&nbsp; logistic&nbsp; regression.&nbsp; Multivariable&nbsp; logistic&nbsp; regression&nbsp; analysis&nbsp; revealed&nbsp; that&nbsp; monocyte&nbsp; count&nbsp; at&nbsp; admission&nbsp; (odds&nbsp; ratio&nbsp; [OR]&nbsp;=&nbsp;1.64;&nbsp;95%&nbsp;confidence&nbsp;interval&nbsp;[CI],&nbsp;1.04 2.65;&nbsp;P&nbsp;=&nbsp;0.036)&nbsp;and&nbsp;systemic&nbsp;inflammatory&nbsp;index&nbsp; score&nbsp;at&nbsp;days&nbsp;3 4&nbsp;(OR&nbsp;=&nbsp;1.55;&nbsp;95%&nbsp;CI,&nbsp;1.02 2.47;&nbsp;P&nbsp;=&nbsp;0.049)&nbsp;were&nbsp;independent&nbsp;predictors&nbsp;of&nbsp;DCI.&nbsp; _x000D_ <br>_x000D_ <br>Conclusions&nbsp; _x000D_ <br>Monocyte&nbsp; count&nbsp; at&nbsp; admission&nbsp; and&nbsp; systemic&nbsp; inflammatory&nbsp; index&nbsp; score&nbsp; 3 4&nbsp; days&nbsp; after&nbsp; rupture&nbsp; are&nbsp; independent&nbsp;predictors&nbsp;of&nbsp;clinical&nbsp;deterioration&nbsp;caused&nbsp;by&nbsp;DCI&nbsp;after&nbsp;aSAH.&nbsp;Peripheral&nbsp;monocytosis&nbsp; may&nbsp;be&nbsp;the&nbsp;primer&nbsp;for&nbsp; at&nbsp; days&nbsp;3 4&nbsp;can&nbsp;promptly&nbsp;represent&nbsp;the&nbsp;propagated&nbsp;systemic&nbsp;immune&nbsp;reaction&nbsp;toward&nbsp;DCI.&nbsp; Keywords:&nbsp;Monocyte&nbsp;count,&nbsp;Systemic&nbsp;immune-inflammation&nbsp;index&nbsp;score,&nbsp;Delayed&nbsp;cerebral&nbsp; ischemia,&nbsp;Aneurysmal&nbsp;subarachnoid&nbsp;hemorrhage&nbsp;