Effect of Tranexamic Acid on Intra- and Postoperative Bleeding in Eyelid Surgery: A Prospective, Randomized, Multicenter, Double-Masked, Control Trial.

PURPOSE: Pilot studies suggest that waiting 15 minutes after a subcutaneous tranexamic acid injection is associated with decreased intraoperative bleeding and postoperative ecchymosis in eyelid surgery. The outcomes of commencing eyelid surgery immediately after injection without a waiting period remain unexplored. METHODS: This prospective, randomized, multicenter, double-masked, controlled study examined bilateral symmetric upper and/or lower lid blepharoplasty or ptosis repair. Patients received tranexamic acid in 1 eyelid and control in the contralateral eyelid. The surgeon recorded the side with more intraoperative bleeding. Two masked graders evaluated periocular ecchymosis at postoperative day 0 and postoperative week 1 (POW 1) with a 5-point scale. At POW 1, patients reported subjective grading of bruising as increased on 1 side or similar on both sides. Results were analyzed with Wilcoxon signed-rank and sign tests. RESULTS: Of 130 patients, there was less eyelid ecchymosis on the tranexamic side at postoperative day 0 ( p = 0.001) and POW 1 ( p < 0.001). By surgery type, the 69 levator advancement surgeries had significantly less ecchymosis at postoperative day 0 ( p < 0.001) and POW 1 ( p = 0.001), while upper eyelid blepharoplasty, combined upper and lower lid blepharoplasty, and conjunctivomullerectomy trended toward significance. Of 68 patients reporting a POW 1 grading, 69% reported less bruising on the tranexamic side ( p < 0.001). Intraoperative bleeding was not significantly different between sides ( p = 0.930). CONCLUSIONS: Without a postinjection waiting period, subcutaneous tranexamic acid for eyelid surgery significantly decreased postoperative ecchymosis on postoperative day 0 and POW 1 but did not affect intraoperative bleeding. Subcutaneous tranexamic acid was not associated with any complications.

The Role of Serum Monocytes and Tissue Macrophages in Driving Left Ventricular Systolic Dysfunction and Cardiac Inflammation Following Subarachnoid Hemorrhage.

BACKGROUND: Neurocardiogenic injury is common after aneurysmal subarachnoid hemorrhage (aSAH) despite low prevalence of preexisting cardiac disease. Potential mechanisms include autonomic dysregulation due to excess catecholamines as well as systemic inflammation. Understanding how inflammation contributes to cardiac dysfunction may aid in identifying novel therapeutic strategies. Here, we investigated serum leukocytes as predictors of left ventricular systolic dysfunction in patients with aSAH. We also investigated increased cardiac macrophages in an animal model of SAH and whether immunomodulatory treatment could attenuate this inflammatory response. METHODS: We retrospectively analyzed 256 patients with aSAH admitted to University of Illinois Hospital between 2013 and 2019. Our inclusion criteria included patients with aSAH receiving an echocardiogram within 72 h of admission. Our primary outcome was echocardiographic evidence of systolic dysfunction. We performed multinomial regression and receiver operating curve analysis. We also used the endovascular perforation model of SAH in male Sprague-Dawley rats to assess for myocardial inflammation. Two days after surgery, hearts were collected and stained for the macrophage marker Iba-1. We compared the presence and morphology of macrophages in cardiac tissue isolated from SAH animals and sham controls treated with and without the immunomodulatory agent fingolimod. RESULTS: Of 256 patients with aSAH, 233 (91.0%) underwent echocardiography within 72 h of admission. Of 233, 81 (34.7%) had systolic dysfunction. Patients had baseline differences in the presence of hypertension, alcohol use, and admission Glasgow Coma Scale and Hunt-Hess score. On multivariable analysis, total leukocytes (odds ratio 1.312, p < 0.001), neutrophils (odds ratio 1.242, p = 0.012), and monocytes (odds ratio 6.112, p = 0.008) were independent predictors of reduced systolic function, whereas only monocytes (odds ratio 28.014, p = 0.030) predicted hyperdynamic function. Within the rodent heart, there were increased macrophages after SAH relative to controls, and this was attenuated by fingolimod treatment (p < 0.0001). CONCLUSIONS: Increased serum leukocytes are associated with abnormal left ventricular systolic function following aSAH. The strongest independent predictor of both reduced and hyperdynamic systolic function was increased monocytes. Increased cardiac macrophages after experimental SAH can also be targeted by using immunomodulatory drugs.

Sentinel lymph node assessment in melanoma: current state and future directions.

Assessment of sentinel lymph node status is an important step in the evaluation of patients with melanoma for both prognosis and therapeutic management. Pathologists have an important role in this evaluation. The methodologies have varied over time, from the evaluation of dimensions of metastatic burden to determination of the location of the tumour deposits within the lymph node to precise cell counting. However, no single method of sentinel lymph node tumour burden measurement can currently be used as a sole independent predictor of prognosis. The management approach to sentinel lymph node-positive patients has also evolved over time, with a more conservative approach recently recognised for selected cases. This review gives an overview of past and current status in the field with a glimpse into future directions based on prior experiences and clinical trials.

TransTok - An analysis of surgical gender affirmation content on TikTok.

PURPOSE: Social media platforms are popular sources of medical information but may harbor harmful misinformation. This study aims to evaluate the effect of TikTok on the transgender population, which may be more likely to seek information from non-traditional sources because of high medical mistrust. METHODS: Twenty gender affirmation related hashtags were queried, with the top 25 videos per hashtag included for analysis. Videos were categorized based on the content and creator. Variables included likes, comments, shares, and video views. All "educational" videos were analyzed for reliability of information using a modified DISCERN (mDISCERN) score and the Patient Education Materials Assessment Tool (PMAT). Kruskal-Wallis H tests, Mann-Whitney U tests, and simple linear regression models were used in analysis. RESULTS: A total of 429 videos amassed 571,434,231 views, 108,050,498 likes, 2,151,572 comments, and 190,9744 shares. Patients were the majority of content creators (74.88%), with patient experiences being the majority of videos (36.07%). Non-physician creators had significantly higher likes and comments when compared to physicians (6185 vs. 1645, p = 0.028; 108 vs. 47, p = 0.016 respectively). Sixty "educational" videos were included in information reliability analysis. There were no significant differences between video characteristics of different content creators, even after stratifying according to physician status. Significant differences were observed in the reliability of information according to PMAT and mDISCERN scores, with physician created videos being significantly higher rated than non-physician created videos (0.90 vs. 0.84, p < 0.001; 3 vs. 2, p < 0.001, respectively). CONCLUSION: Lower quality information is associated with non-physician content creators. We encourage physicians to be continuously involved in creating quality information on TikTok.

Cross-Sectional 4D-Printing: Upscaling Self-Shaping Structures with Differentiated Material Properties Inspired by the Large-Flowered Butterwort (Pinguicula grandiflora).

Extrusion-based 4D-printing, which is an emerging field within additive manufacturing, has enabled the technical transfer of bioinspired self-shaping mechanisms by emulating the functional morphology of motile plant structures (e.g., leaves, petals, capsules). However, restricted by the layer-by-layer extrusion process, much of the resulting works are simplified abstractions of the pinecone scale's bilayer structure. This paper presents a new method of 4D-printing by rotating the printed axis of the bilayers, which enables the design and fabrication of self-shaping monomaterial systems in cross sections. This research introduces a computational workflow for programming, simulating, and 4D-printing differentiated cross sections with multilayered mechanical properties. Taking inspiration from the large-flowered butterwort (Pinguicula grandiflora), which shows the formation of depressions on its trap leaves upon contact with prey, we investigate the depression formation of bioinspired 4D-printed test structures by varying each depth layer. Cross-sectional 4D-printing expands the design space of bioinspired bilayer mechanisms beyond the XY plane, allows more control in tuning their self-shaping properties, and paves the way toward large-scale 4D-printed structures with high-resolution programmability.

Are you alone? Measuring solitude in childhood, adolescence, and emerging adulthood.

The goal of this review was to provide an overview of how solitude has been operationally defined and measured since the year 2000 in psychological studies of children, adolescents, and emerging adults. After applying exclusionary criteria, our review of the extant literature identified n = 19 empirical studies, which we grouped into three broad methodological categories: (1) experiments/manipulations (n = 5); (2) retrospective reports (n = 7); and (3) experience sampling measures (experience sampling methodology; n = 7). A review of these studies indicated considerable variation in how solitude is operationalized and measured. There is also a notable lack of studies measuring solitude in childhood. Implications for 'what matters' when assessing solitude are discussed, and we provide a series of suggestions for helping this research area move forward.

Codesign of Biobased Cellulose-Filled Filaments and Mesostructures for 4D Printing Humidity Responsive Smart Structures.

Hygromorphic smart structures are advantageous as passively actuated systems for generating movement, with applications ranging from weather-responsive architectural building skins to adaptive wearables and microrobotics. Four-dimensional (4D) printing is a valuable method for multiscale fabrication and physical programming of such structures. However, material limitations in terms of printability, responsiveness, and mechanical properties are major bottlenecks in achieving reliable and repeatable humidity-responsive actuation. We propose a codesign method for 4D printing hygromorphic structures through fused filament fabrication, incorporating parallel development of (1) biobased cellulose-filled filaments with varying stiffness and hygroresponsiveness, and (2) designed mesoscale structuring in printed elements. We first describe the design of a pallet of filaments produced by compounding cellulose powder in mass ratios of 0-30% within two matrix polymers with high and low stiffness. We then present the design, fabrication, and testing of a series of 4D-printed prototypes tuned to change shape, that is, open and close, in response to relative humidity (RH). The structures can fully transform in conditions of 35-90% RH, which corresponds to naturally occurring shifts in RH in daily and seasonal weather cycles. Furthermore, their motion is fast (within the range of minutes), fully reversible, and repeatable in numerous cycles. These results open new opportunities for the utilization of 4D printing and natural resources for the development of functional humidity-responsive smart structures.

Pseudocholinesterase deficiency in ophthalmology: a systematic review.

PURPOSE: Unexpected anesthesia-related complications are among the most feared outcomes of ambulatory surgery. One potential culprit is pseudocholinesterase deficiency, which most commonly presents with protracted apnea, necessitating prolonged mechanical ventilation. We report the first case of pseudocholinesterase deficiency in a Bengali person and the first systematic review of pseudocholinesterase deficiency in ophthalmology. This review analyzed the epidemiology, etiologies, presentation, evaluation, and treatment of pseudocholinesterase deficiency. METHODS: Searches were conducted in PubMed, Embase, and Medline through August of 2022 for publications related to pseudocholinesterase deficiency in ophthalmology. In total, 689 studies were screened by two independent reviewers with 26 full-text articles examined for inclusion eligibility. Nineteen studies were eligible and included in the final analysis. RESULTS: Of the 16 identified cases of pseudocholinesterase deficiency, nine (56%) were drug-induced, four (25%) were inherited deficiencies, and in one (6%) of the cases, the cause could not be determined. In two (13%) cases, pseudocholinesterase deficiency could not be confirmed or ruled out. The duration of post-operative apnea ranged from 10 minutes to 14 hours. Continued ventilatory support was the main treatment for all cases and all patients made a full recovery. CONCLUSIONS: Pseudocholinesterase deficiency is a rare, but potentially fatal, anesthetic complication that results in prolonged apnea, respiratory distress, and dependency on ventilators. Ophthalmologists should remain aware of this condition, especially when planning outpatient procedures, as ambulatory centers may have limited resources for managing prolonged post-operative complications.

Gender Authorship Trends Among Craniofacial Publications: A 20-Year Analysis.

This study aims to identify gender disparities within the subspecialty of craniofacial surgery as women surgeons remain underrepresented in academia and leadership, arenas heavily dictated by research productivity.All craniofacial articles published in 3 major research journals from 2000 to 2020 were reviewed and evaluated in 5-year increments.Information regarding author gender, authorship distribution, geographic origin, and publication type was collected. ANOVA, χ2, and logistic regression modeling were used for analysis.In total, there were 3684 articles with 15 206 total authors-3128 (20.6%) were women, including 665 (21.3%) first authors, 1980 (63.2%) middle authors, and 487 (15.7%) senior authors. Mean women authorship increased significantly from 2000 to 2020 (0.33 vs 1.22 P < .001) with corresponding significant increases in first and senior authorship (8.63% vs 27.02; 5.65% vs 16.13%; P < .001). Statistically significant trends across time were observed for first and senior authorships (P < .001). Women were more likely to publish original publications as first and senior authors (OR: 1.83, P < .001; OR: 1.37, P = .0012). Women were less likely to publish editorial articles (OR 0.6, P < .001). The United States ranked third in publication output by female first authors but was behind all regions except Africa for output by female senior authors.Although female authorship has increased significantly over the last 2 decades, women remain a minority within the craniofacial literature. Further research is needed to elicit the root of these disparities.

Skin Color Representation in Ophthalmology Textbooks.

Objective: Inadequate diversity in dermatologic images has been associated with diagnostic delays and poorer health outcomes. This underrepresentation of darker skin tones has also been demonstrated across various fields of medicine, including rheumatology, urology, and in the COVID-19 pandemic. The distribution of skin tones has not been examined in educational ophthalmology texts. The authors aimed to quantify the representation of skin tones across three leading ophthalmology textbooks. Methods: Two independent investigators utilized the Fitzpatrick's skin phototype scale to code images containing skin as either "light" (Fitz. I-IV) or "dark" (Fitz. V-VI) in three fundamental ophthalmology textbooks: Clinical Ophthalmology (Salmon and Kanski), Ophthalmology (Yanoff and Duker), and the 13 Basic and Clinical Science Course texts by the American Academy of Ophthalmology. Images without discernible skin color were excluded. Results: Of the 9766 images reviewed, 2305 images met inclusion criteria. The three textbooks combined were found to have 2123 (92.1%) images of light skin tones and 182 images (7.9%) of dark skin tones. When compared to national data that found 12.6% of individuals to have dark skin tones, the proportion of images with darker skin tones in ophthalmology textbooks was statistically significantly lower (χ 2 corr(1, N = 4996) = 211.7, p < 0.001). Conclusions: Darker skin tones are statistically significantly underrepresented in textbooks that are central to education of trainees in ophthalmology. Acknowledgement and inclusion of skin tone diversity in ophthalmology educational materials are necessary to ensure that physicians in the field are equipped with the knowledge and training to provide the highest level of care to all patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01636-4.

The Spectrum of Spitz Melanocytic Lesions: From Morphologic Diagnosis to Molecular Classification.

Spitz tumors represent a distinct subtype of melanocytic lesions with characteristic histopathologic features, some of which are overlapping with melanoma. More common in the pediatric and younger population, they can be clinically suspected by recognizing specific patterns on dermatoscopic examination, and several subtypes have been described. We now classify these lesions into benign Spitz nevi, intermediate lesions identified as "atypical Spitz tumors" (or Spitz melanocytoma) and malignant Spitz melanoma. More recently a large body of work has uncovered the molecular underpinning of Spitz tumors, including mutations in the HRAS gene and several gene fusions involving several protein kinases. Here we present an overarching view of our current knowledge and understanding of Spitz tumors, detailing clinical, histopathological and molecular features characteristic of these lesions.

A 20-Year Analysis of Global Authorship Trends in Craniofacial Literature: Is the United States Falling Behind?

INTRODUCTION: Recent advances in craniofacial surgery have occurred in conjunction with a global proliferation of research. Although previous studies have examined geographic publication trends, little is known about these trends in the craniofacial literature. METHODS: All craniofacial articles published from 2000 to 2020 in 3 premier craniofacial surgery journals were evaluated in 5-year increments. Geographic origin, manuscript type, and authorship characteristics were collected. Changes in publication output, geographic origin, and content were analyzed. RESULTS: In total 3864 articles were analyzed, with the United States (U.S.) (33.46%) accounting for the majority, followed by Asia (27.04%), the Middle East (16.23%), and Europe (14.65%). The proportion of articles from the U.S. decreased significantly in the in the 20-year span (48.28% versus 33.53%, P < 0.001), whereas those originating from Asia and the Middle East increased significantly (18.62% versus 31.41% and 10.34% versus 15.66%, respectively, P < 0.001). After stratifying and selecting for regions with the greatest changes in publication output, the authors observed significant trends for the number of original investigations from 2000 to 2020 in the U.S. (Odds Ratio [OR] 1 versus 2.4, P < 0.001) and in Asia (OR 1 versus 1.8, P = 0.0052). Additionally, a significant trend in editorial/correspondence publications originating in the U.S. (OR 1 versus 0.74, P = 0.0102), Europe (OR 1 versus 0.38, P = 0.0186), and Asia (OR 1 versus 0.48, P = 0.0051) was observed. CONCLUSIONS: Despite rising craniofacial publications over the past 2 decades, there has been a diminishing proportion originating from the U.S.

Elevated Serum Leukocytes are Predictive of Cardiac Injury Following Aneurysmal Subarachnoid Hemorrhage.

OBJECTIVES: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of strokes but results in significant morbidity and mortality. In addition to systemic inflammation, up to half of patients develop cardiac injury; however, the relationship between systemic inflammation and cardiac injury after aSAH is unknown. We investigated changes in leukocyte counts in relation to cardiac dysfunction MATERIALS AND METHODS: We reviewed the records of consecutive patients with SAH at our large academic medical referral center. The inclusion criteria were aSAH and available cardiac troponin I (cTnI) levels within 48 h of admission. The primary outcome was cardiac injury, defined as cTnI ≥0.04 ng/mL (lab reference range 0.01-0.03 ng/mL). We compared baseline characteristics, including serum leukocyte counts and performed univariable and multivariable logistic regression analysis to determine whether changes in leukocyte subpopulations predict cardiac injury. RESULTS: Of 288 SAH patients, 250 met inclusion criteria. Of these, 116 (46.4%) had elevated cTnI. In univariable analysis, total leukocyte count (p < 0.001), absolute neutrophil count (ANC, p < 0.001), and absolute monocyte count (p = 0.013), were associated with elevated cTnI. in multivariable analysis, total leukocyte count (OR=1.079, p = 0.037) and ANC (OR=1.081, p = 0.044) remained predictors of elevated cTnI. Adjusted ANC distinguishes between aSAH patients with normal and elevated TnI (area under the curve=0.766, p < 0.001) with specificity of 89.2%. CONCLUSIONS: Elevated total leukocytes and ANC are independently associated with cardiac injury in aSAH. Systemic inflammatory responses after aSAH may play a role in cardiac dysfunction, warranting additional studies to further characterize how cardiac inflammation after aSAH drives subsequent morbidity and mortality.

#Oculoplastics: An Analysis of TikTok's Top Oculoplastics Content.

PURPOSE: To analyze the source and quality of oculoplastics-related content on TikTok, a popular social media platform. METHODS: Twenty-five oculoplastics-related hashtags were queried. The top 20 videos for each hashtag were included. The number of views, likes, comments, and shares were recorded for each video. Each video was also categorized by the account owner and by video content characteristics. A subanalysis of the educational videos was conducted using the mDISCERN, Patient Education Materials Assessment Tool, and modified MICI scores to assess video quality, understandability and actionability, and medical accuracy, respectively. RESULTS: The included 386 videos amassed 218,997,134 views, 15,033,220 likes, 148,099 comments, and 276,445 shares. Patients were the leading content creators (38.1%), followed by nonophthalmology MDs/DOs (25.6%), and oculoplastic surgeons/ophthalmologists (16.3%). Physician-created videos received more visibility than nonphysician-created videos (median of 23,600 views and 22 shares), though this did not reach statistical significance. However, oculoplastic surgeon-posted content received the lowest median views and shares. The video category that amassed the most views was "live procedure/surgeries," followed by "educational" and "patient experience." Subanalysis of 46 educational videos revealed physicians were the chief creators, accounting for 67.4% of all educational videos. Physician-created content demonstrated statistically significant better understandability and actionability, as measured by the Patient Education Materials Assessment Tool ( p = 0.0053). CONCLUSION: Physicians play an important role in disseminating evidence-based medicine on social media. While oculoplastics-related TikTok videos are gaining traction, additional research is needed to improve the visibility of oculoplastic-surgeon posted content.

Shared Decision Making in Ophthalmology: A Scoping Review.

PURPOSE: Shared decision making (SDM) has been associated with improved patient satisfaction and outcomes in both medical and surgical specialties, but its role in ophthalmology has not been systematically examined. Using a scoping review of the literature, the purpose of this study was to explore the characteristics, implementation, and outcomes of SDM in ophthalmology. DESIGN: Scoping review of the literature. METHODS: Searches were conducted in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials through August 2021 for SDM in ophthalmology. The resulting 1602 studies were screened by 2 independent reviewers with 57 full-text articles examined for inclusion of an ophthalmologic diagnosis, as well as discussion of SDM or patient decision aids. Nineteen studies were eligible and qualitatively coded for 11 predetermined codes, which included patient outcomes, patient and physician requests for SDM, and methods of implementation. RESULTS: Of 19 included studies, all emphasized the value of SDM for ophthalmology and 2 studies reported improved patient outcomes. The most commonly examined topics were chronic ophthalmic diseases, such as cataracts and glaucoma. Limitations to SDM implementation were also universally discussed, including patients' lack of disease knowledge, communication barriers, and time restrictions. Although patient decision aids are an effective tool to mitigate these limitations, these have only been established for the subjects of cataracts and glaucoma. CONCLUSION: SDM is a methodology for patient-centered care that is regarded as a potentially useful tool in the field of ophthalmology. However, significant barriers exist to its effective implementation. Evidence-based research on if and how these barriers should be attenuated, as well as the development of additional patient decision aids for different ophthalmic diseases, are needed.

Pediatric firearm injury trends in the United States: A national trauma data bank (NTDB) analysis.

AIM OF STUDY: Firearm injuries are the second leading cause of injury-related death in the USA in children less than 18. We compared overall and intent-specific firearm hospitalizations across age group and race to understand recent trends. METHODS: A retrospective cohort of 20,083 children from the national trauma data bank involved in incidences of firearm discharges from 2013 to 2017 was divided by race, discharge intent, gun type, and four age groups: infants (ages 0-2), toddlers (3-6), children (7-12), and adolescents (13-18). Discharge intent and gun type were determined by ICD-9-CM and ICD-10-CM External Causes of Injury codes. Injury severity score (ISS), hospital discharge disposition, and length of stay (LOS) were used as predictors for morbidity and mortality. RESULTS: From 2013 to 2017, there were on an average 4016 firearm injuries reported to the NTDB (n = 20,083). 71% (n = 14,313) of the incidents were assaults. Victims who identified as African American and Caucasian made up 60% (n = 11,890) and 26% (n = 5162) of the total victims, respectively, and were predominantly male (86%, n = 17,202). Victims who identified as Caucasian made up 70% of suicides (n = 819), while African Americans made up 70% of assaults (n = 9733). 87% (n = 17,525) of the patient population were adolescents. The number of accidental firearm discharges compared to firearm assaults was greater for toddlers, while the opposite was true for infants, children, and adolescents. Average LOS by age group varied each year, though children had the highest total average LOS.  Average ISS was highest for infants and adolescents (11.5 and 10.4) and American Indians and Caucasians (10.1 and 11.1). Overall mortality rate was 6% (n = 1220) and had no significant differences between years. Mortality rate was highest for infants (7%, n = 25). CONCLUSIONS: Adolescent males and African Americans were disproportionately affected by overall and assault-specific firearm discharges. Firearm injury prevention legislation is critical to prevent these injures.

Eating Disorder Symptomatology Among Adolescents Presenting for Bariatric Surgery Candidacy: Examining Differences by Sex and Racial Minority Status.

BACKGROUND: Research on adolescent bariatric surgery candidates is limited by insufficient inclusion of ethnic minorities and males, and lack of consideration of the full spectrum of disordered eating behaviors (i.e., restriction, compensatory behaviors [e.g., purging], overeating/binge eating behaviors). OBJECTIVES: The current study investigated differences in the full range of disordered eating behaviors across sex and ethnicity among adolescents seeking bariatric surgery. SETTING: Teaching hospital, United States. METHODS: Data were collected using retrospective chart review of 79 adolescent bariatric surgery candidates (59% female, 46.8% Hispanic, MBMI = 50.2, SDBMI = 10.0, Mage = 17.3, SDage = 2.02) who had completed the self-reported Eating Disorder Diagnostic Scale for DSM-5 at intake. RESULTS: Approximately 33% of study participants met self-reported criteria for an eating disorder, with 35% endorsing binge eating behaviors and 50% endorsing compensatory behaviors. Few differences in behavior frequencies were observed across sex or racial/ethnic status. CONCLUSIONS: Findings underscore the importance of assessing the full spectrum of disordered eating behaviors among adolescent bariatric surgery candidates.

Systemic Immune-Inflammation Index Predicts Delayed Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND: Delayed cerebral vasospasm is a feared complication of aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE: To investigate the relationship of systemic inflammation, measured using the systemic immune-inflammation (SII) index, with delayed angiographic or sonographic vasospasm. We hypothesize that early elevations in SII index serve as an independent predictor of vasospasm. METHODS: We retrospectively reviewed the medical records of 289 SAH patients for angiographic or sonographic evidence of delayed cerebral vasospasm. SII index [(neutrophils × platelets/lymphocytes)/1000] was calculated from laboratory data at admission and dichotomized based on whether or not the patient developed vasospasm. Multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed to determine the ability of SII index to predict the development of vasospasm. RESULTS: A total of 246 patients were included in our study, of which 166 (67.5%) developed angiographic or sonographic evidence of cerebral vasospasm. Admission SII index was elevated for SAH in patients with vasospasm compared to those without (P < .001). In univariate logistic regression, leukocytes, neutrophils, lymphocytes, neutrophil-lymphocyte ratio (NLR), and SII index were associated with vasospasm. After adjustment for age, aneurysm location, diabetes mellitus, hyperlipidemia, and modified Fisher scale, SII index remained an independent predictor of vasospasm (odds ratio 1.386, P = .003). ROC analysis revealed that SII index accurately distinguished between patients who develop vasospasm vs those who do not (area under the curve = 0.767, P < .001). CONCLUSION: Early elevation in SII index can independently predict the development of delayed cerebral vasospasm in aneurysmal SAH.