gms | German Medical Science

Objective: Aneurysmal subarachnoid haemorrhage (aSAH) remains a serious, life-threatening disease associated with high morbidity and mortality despite recent advances in neurocritical care as well as neurosurgical and endovascular treatment options. A multitude of pathological processes, such as inflammatory and vasospastic events can determine the clinical course after the initial bleeding event, however predictive factors and therapeutic consequences are scarce. We analysed the changes in white blood cell (WBC) count depending on steroid medication within the first 14 days after aSAH as a parameter for delayed cerebral ischemia (DCI)

Methods: All patients admitted from 11/2010 to 05/2018 with the diagnosis of aneurysmal SAH (488 patients in total) were included in this retrospective study. Dexamethasone treatment was defined as any administration of >4mg dexamethasone during the clinical stay. Leucocytosis for any given point of time was defined as commonly agreed on (>11.000/µl), while persistent leukocytosis was defined as a leukocytosis within the first 72h that was still present at day 7. Statistical analysis of the data was performed by univariate analysis using chi-squared and ANOVA tests to examine correlations between the parameters followed by a multivariate regression analysis

Results: The occurrence of DCI was associated with initial hydrocephalus, (p<0.001), ventriculitis/meningitis (p<0.01), vasospasms (p<0.001), initial (p<0.006) and persistent leukocytosis (p<0.022). Mean dexamethasone dosage was 123.4 mg, overall 233/488 patients received dexamethasone. A multivariate regression for the appearance of DCI, leukocytosis within 72h proved to be the only independently significant factor apart from the H&H score (p<0.001). Under dexamethasone treatment, the correlation with H&H score remained the same (p<0.001; OR: 1.5), whereas the significance with leucocytosis for any given timepoint was lost (p<0.63). For patients without dexamethasone treatment, the correlation with H&H score was lost (p<0.975) and leukocytosis at day7 and persistent leukocytosis remained the only significantly parameters (d7: p<0.001; OR:1.1; persistent leucocytosis p<0.01; OR: 2.1)

Conclusion: Leucocytosis independently correlates with DCI in aSAH patients. Interestingly, the correlation with WBC can only be drawn in patients that did not receive steroids in their course of treatment. This has currently been neglected in previous studies, underlining the importance of evaluating this parameter in future studies.