Neutrophil Counts as Promising Marker for Predicting In-Hospital Mortality in Aneurysmal Subarachnoid Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Yu Zhang ◽  
Linjie Li ◽  
Lu Jia ◽  
Tiangui Li ◽  
Yuanyuan Di ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Odds Ratio ◽  
Prognostic Value ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Inflammatory Factors ◽  
Hospital Acquired Infections ◽  
Hospital Acquired

Background and Purpose: Systemic inflammation is recognized as a hallmark of stroke. We aimed to evaluate the prognostic value of various inflammatory factors using blood at admission in patients with aneurysmal subarachnoid hemorrhage. Methods: In a multicenter observational study of patients with aneurysmal subarachnoid hemorrhage, the counts of neutrophil, platelet, and lymphocyte were collected on admission. Patients were stratified based on neutrophil counts with propensity score matching to minimize confounding. We calculated the adjusted odds ratios with 95% CIs for the primary outcome of in-hospital mortality and hospital-acquired infections. Results: A total of 6041 patients were included in this study and 344(5.7%) of them died in hospital. Propensity score matching analyses indicated that compared with the lower neutrophil counts, higher neutrophil counts were associated with increased risk of in-hospital mortality (odds ratio, 1.53 [95% CI, 1.14–2.06]), hospital-acquired infections (odds ratio, 1.61 [95% CI, 1.38–1.79]), and delayed neurological ischemic deficits (odds ratio, 1.52 [95% CI, 1.09–1.97]). Moreover, out of all the inflammatory factors studied, neutrophil counts demonstrated the highest correlation with in-hospital mortality and hospital-acquired infections. Conclusions: Among patients with aneurysmal subarachnoid hemorrhage, high neutrophil counts at admission were associated with increased mortality and hospital-acquired infections. The neutrophil count is a simple, useful marker with prognostic value in patients with aneurysmal subarachnoid hemorrhage.

scholarly journals Impact of Chronic Obstructive Pulmonary Disease on In-hospital Mortality in Patients with Aneurysmal Subarachnoid Hemorrhage: An Observational Cohort Study with Propensity Score Matching

2020 ◽  
Author(s):  
Yu Zhang ◽  
Linjie Li ◽  
Wei Yao ◽  
Xing Wang ◽  
Liyuan Peng ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Pulmonary Disease ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Objective: Chronic obstructive pulmonary disease (COPD) has been associated with several complications and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between COPD and clinical outcomes remains unclear. Methods: In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2009 and 2019. Propensity score matching was performed to obtain the adjusted odds ratios (ORs) with 95% CI. The primary outcome was in hospital mortality.Results: Using a ten-year clinical database from a large university medical center, 5643 patients with aSAH were identified, of whom 377 (7.9%) also had COPD. After matching, 289 patients were included in COPD group and 1156 in non-COPD groups. COPD was associated with increased in-hospital mortality (OR 1.63, 95% CI 1.02-2.62) and poor functional outcome at discharge (OR 1.37, 95% CI 1.04-1.80). Similarly, patients with COPD had significantly longer length of hospital stay, higher odds of seizure (OR 2.05, 95% CI 1.04-4.04), pneumonia (OR 3.10, 95% CI 2.38-4.04), intracranial infection (OR 1.62, 95% CI 1.14-2.29), urinary tract infection (OR 1.59, 95% CI 1.16-2.20) and bloodstream infection(OR 3.27, 95% CI 1.74-6.15). Conclusions: Among aSAH patients, COPD is associated with increased mortality. COPD represents a significant risk factor for pneumonia and seizure.

scholarly journals Serum glutamine and hospital-acquired infections after aneurysmal subarachnoid hemorrhage

Neurology ◽  
2018 ◽  
Vol 91 (5) ◽  
pp. e421-e426 ◽  
Author(s):  
Neeraj Badjatia ◽  
Serge Cremers ◽  
Jan Claassen ◽  
E. Sander Connolly ◽  
Stephan A. Mayer ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Nitrogen Balance ◽  
Telephone Interview ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cognitive Status ◽  
Inflammatory Factors ◽  
Modified Rankin Scale ◽  
Hospital Acquired Infections ◽  
Increased Risk ◽  
Hospital Acquired

ObjectiveTo understand nutritional and inflammatory factors contributing to serum glutamine levels and their relationship to hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH).MethodsA prospective observational study of patients with SAH who had measurements of daily caloric intake and C-reactive protein, transthyretin, tumor necrosis factor α receptor 1a (TNFαR1a), glutamine, and nitrogen balance performed within 4 preset time periods during the 14 days after SAH. Factors associated with glutamine levels and HAIs were analyzed with multivariable regression. HAIs were tracked daily for time-to-event analyses. Outcome 3 months after SAH was assessed by the Telephone Interview for Cognitive Status and modified Rankin Scale.ResultsThere were 77 patients with an average age of 55 ± 15 years. HAIs developed in 18 (23%) on mean SAH day 8 ± 3. In a multivariable linear regression model, negative nitrogen balance (p = 0.02) and elevated TNFαR1a (p = 0.04) were independently associated with higher glutamine levels during the study period. The 14-day mean glutamine levels were lower in patients who developed HAI (166 ± 110 vs 236 ± 81 μg/mL, p = 0.004). Poor admission Hunt and Hess grade (p = 0.04) and lower glutamine levels (p = 0.02) predicted time to first HAI. Low 14-day mean levels of glutamine were associated with a poor recovery on the Telephone Interview for Cognitive Status score (p = 0.03) and modified Rankin Scale score (p = 0.04) at 3 months after injury.ConclusionsDeclining glutamine levels in the first 14 days after SAH are influenced by inflammation and associated with an increased risk of HAI.

scholarly journals Delayed hospital admission of patients with aneurysmal subarachnoid hemorrhage: clinical presentation, treatment strategies, and outcome

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Lukas Goertz ◽  
Muriel Pflaeging ◽  
Christina Hamisch ◽  
Christoph Kabbasch ◽  
Lenhard Pennig ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Hospital Admission ◽  
Propensity Score Matching ◽  
Clinical Presentation ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Treatment Strategies ◽  
Neurointensive Care ◽  
Secondary Brain Injury ◽  
Care Treatment

OBJECTIVETimely aneurysm occlusion and neurointensive care treatment are key principles in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent secondary brain injury. Patients with early (EHA) and delayed hospital admission (DHA) were compared in terms of clinical presentation, treatment strategies, aSAH-related complications, and outcome.METHODSIn this retrospective study, consecutive aSAH patients were treated at a single neurovascular center between 2009 and 2019. Propensity score matching was performed to account for divergent baseline characteristics.RESULTSAmong 509 included patients, 55 were admitted more than 48 hours after ictus (DHA group). DHA patients were significantly younger (52 ± 11 vs 56 ± 14 years, p = 0.03) and had lower World Federation of Neurosurgical Societies scores (p < 0.01) than EHA patients. In 54.5% of the cases, DHA patients presented with neurological deterioration or aggravated symptoms. Propensity score matching revealed a higher vasospastic infarction rate in the DHA group (41.5%) than in the EHA group (22.6%) (p = 0.04). A similar portion of patients in both groups achieved favorable outcome at midterm follow-up (77.3% vs 73.6%, p = 0.87). DHA patients (62.3%) received conventional coiling more often than EHA patients (41.5%) (p = 0.03).CONCLUSIONSDHA patients are at an increased risk of cerebral infarction. Nevertheless, state-of-the-art neurointensive care treatment can result in a good clinical outcome.

Hospital-Acquired Infections after Aneurysmal Subarachnoid Hemorrhage: A Nationwide Analysis

2016 ◽  
Vol 88 ◽  
pp. 459-474 ◽  
Author(s):  
Hormuzdiyar H. Dasenbrock ◽  
Robert F. Rudy ◽  
Timothy R. Smith ◽  
Donovan Guttieres ◽  
Kai U. Frerichs ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Hospital Acquired Infections ◽  
Hospital Acquired

scholarly journals Strict Glucose Control Does Not Affect Mortality after Aneurysmal Subarachnoid Hemorrhage

2009 ◽  
Vol 110 (3) ◽  
pp. 603-610 ◽  
Author(s):  
Robert H. Thiele ◽  
Nader Pouratian ◽  
Zhiyi Zuo ◽  
David C. Scalzo ◽  
Heather A. Dobbs ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Subarachnoid Hemorrhage ◽  
Hospital Mortality ◽  
Glucose Control ◽  
Odds Ratio ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Risk Of Death ◽  
Increased Risk ◽  
Average Glucose ◽  
Admission Glucose

Background The effects of both hyperglycemia and hypoglycemia are deleterious to patients with neurologic injury. Methods On January 1, 2002, the neurointensive care unit at the University of Virginia Health System initiated a strict glucose control protocol (goal glucose &lt; 120 mg/dl). The authors conducted an impact study to determine the effects of this protocol on patients presenting with aneurysmal subarachnoid hemorrhage. Results Among the 834 patients admitted between 1995 and 2007, the in-hospital mortality was 11.6%. The median admission glucose for survivors was lower (135 vs. 176 mg/dl); however, on multivariate analysis, increasing admission glucose was not associated with a statistically significant increase in the risk of death (P = 0.064). The median average glucose for survivors was also lower (116 vs. 135 mg/dl). This was significant on multivariate analysis (P &lt; 0.001); however, the effect was small (odds ratio, 1.045). Implementation of the strict glucose protocol decreased median average glucose (121 vs. 116 mg/dl, P &lt; 0.001) and decreased the incidence of hyperglycemia. Implementation of the protocol had no effect on in-hospital mortality (11.7% vs. 12.0%, P = 0.876 [univariate], P = 0.132 [multivariate]). Protocol implementation was associated with an increased incidence of hypoglycemia (P &lt; 0.001). Hypoglycemia was associated with a substantially increased risk of death on multivariate analysis (P = 0.009; odds ratio = 3.818). Conclusions The initiation of a tight glucose control regimen lowered average glucose levels but had no effect on overall in-hospital mortality.

scholarly journals P.093 Hemoglobin values, fluctuations from baseline, and transfusion as predictors of outcome following aneurysmal subarachnoid hemorrhage

2018 ◽  
Vol 45 (s2) ◽  
pp. S41-S41
Author(s):  
ME Eagles ◽  
MK Tso ◽  
RL Macdonald
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Roc Curve ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Youden Index ◽  
Predictors Of Outcome ◽  
Roc Curve Analysis ◽  
Transfusion Threshold ◽  
Poor Outcome

Background: Anemia following aneurysmal subarachnoid hemorrhage (aSAH) has been associated with poor outcome, but complications from transfusion have limited aggressive management of anemic patients. This study examined the relationship between hemoglobin levels, transfusion and outcome following aSAH. Methods: We performed a post-hoc analysis of the CONSCIOUS-1 trial. Poor outcome was defined as a 3-month modified Rankin Scale > 2. Minimum hemoglobin levels were evaluated as predictors of outcome using logistic regression analysis, ROC curve analysis, and LOWESS curves. Propensity score matching was used to assess the effect of transfusion on poor outcome in patients with minimum hemoglobin levels between 70-90 and 80-100 g/L. Results: Lower minimum hemoglobin levels were associated with poor outcome on both univariate (p<0.001) and multivariate (p=0.012) analysis. Area under the ROC curve for minimum hemoglobin was 0.673. Youden index analysis found a minimum hemoglobin threshold of 91.5 g/L maximally predictive for good functional outcome. Propensity score matching showed a trend towards poor outcome in transfused patients with minimum hemoglobin levels between 70-90 and 80-100 g/L (p=0.052 and 0.09). Conclusions: This work suggests that decreasing hemoglobin is an independent predictor of poor outcome following aSAH. However, there was a trend towards poor outcome in transfused patients. The optimal transfusion threshold should be evaluated by prospective trials.

Abstract TP434: The Effect of Therapeutic Modalities on Outcomes in Patients With Subarachnoid Hemorrhage: a Nationwide Study Using the Japanese Diagnosis Procedure Combination Database From The J-aspect Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ryota Kurogi ◽  
Akiko Kada ◽  
Kunihiro Nishimura ◽  
Satoru Kamitani ◽  
Ataru Nishimura ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Mixed Model ◽  
Diagnosis Procedure Combination ◽  
Nationwide Study ◽  
Mixed Model Analysis ◽  
Propensity Score Matching Analysis ◽  
Training Institutions

Background and Purpose: The effects of the clipping or coiling treatment on patients with subarachnoid hemorrhage (SAH) remain elusive. We performed a nationwide study to compare the effects of clipping with those of coiling in patients with SAH by using the Japanese Diagnosis Procedure Combination (DPC) database. Materials and methods: We analyzed data obtained from patients who were hospitalized for SAH in 427 certified training institutions of the Japan Neurosurgical Society between April 2012 and March 2013. Outcomes regarding in-hospital mortality, modified Rankin Scale (mRS) scores, cerebral infarction, and complications were compared between clipping and coiling groups using mixed model analysis and propensity score matching analysis. In addition, we conducted a questionnaire-based survey regarding comprehensive stroke center (CSC) capabilities. The questionnaire elicited data regarding the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs in 749 professional training institutions on February 2011. Results: Data obtained from a total of 5214 patients with SAH (3624 clipping, 1590 coiling) were analyzed. Mixed model analysis (OR=1.30, P=0.013) and propensity score matching analysis (OR=1.35, P=0.022) revealed that the in-hospital mortality was significantly higher in the coiling group, while both analyses revealed that the discharge mRS was not significantly different between groups. Clipping of intracranial aneurysms (IAs) and operating rooms staffed 24/7 were available in 91.5% and 60.4% of 749 hospitals, respectively. Coiling of IAs and interventional services coverage 24/7 were available in 48.1% and 37.3% of 749 hospitals, respectively. Conclusions: This study demonstrated that clipping is superior to coiling for SAH patients. In Japan, the number of hospitals where coiling is available is still considerably lower than the number of hospitals where of clipping is available. The differences among hospitals may be associated with the increased in-hospital mortality in the patients undergoing coiling. This nationwide database study can complement the findings of prospective clinical trials, and reflect real-world practice.

scholarly journals Prognostic value of Onodera’s nutritional index for intermediate- and high-risk gastrointestinal stromal tumors treated with or without tyrosine kinase inhibitors

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Feng Wang ◽  
Tingting Tao ◽  
Heng Yu ◽  
Yingying Xu ◽  
Zhi Yang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Prognostic Marker ◽  
Gastrointestinal Stromal Tumors ◽  
Prognostic Value ◽  
Kinase Inhibitors ◽  
Rank Test ◽  
Stromal Tumors ◽  
Lymphocyte Ratio ◽  
Nutritional Index

Abstract Background Immunoinflammatory and nutritional markers, such as the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and Onodera’s prognostic nutritional index (OPNI), have gained considerable attention and have been preliminarily revealed as prognostic markers of gastrointestinal stromal tumors (GISTs). Methods In this study, we first investigated the prognostic value of OPNI in GISTs treated with or without TKIs based on the propensity score matching (PSM) method. All of the patients had received surgical resection for primary GIST, and data from 2010 to 2018 were initially and retrospectively identified from our gastrointestinal center. Recurrence-free survival (RFS) was calculated by the Kaplan–Meier method and compared by the log-rank test. Results The patients were divided into groups treated and not treated with TKIs, and we used the propensity score matching method to homogenize their baseline data. Multivariate Cox proportional hazard regression models were applied to identify associations with outcome variables. A total of 563 GISTs were initially chosen, and 280 of them were included for analysis under the inclusion criteria. After PSM, there were 200 patients included. Multivariate analyses identified OPNI as an independent prognostic marker that was associated with primary site, tumor size, mitotic index, tumor rupture, necrosis, and modified NIH risk classification. Low OPNI (< 42.6; HR 0.409; P < 0.001) was associated with worse RFS. Conclusions Preoperative OPNI is a novel and useful prognostic marker for GISTs both treated and not treated with TKIs. Higher NLR and PLR have negative effects on RFS.

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