ABSTRACT
PURPOSE: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality, but currently no single clinical method or ancillary test can reliably predict which subset of patients will develop delayed cerebral ischemia (DCI). The aim of this study was to find hematologic derangements and clinical factors present during the first 7 days after bleeding that could help identify patients at risk for development of DCI. MATERIALS AND METHODS: Databank analysis of patients with SAH admitted between 2010 and 2012 in a single center. Data from demographics, imaging, laboratory, and clinical factors were collected. Statistical testing was conducted to test for association to the outcome, and multivariate logistic regression was used to design a predictive model. RESULTS: Of 55 patients, 14 developed DCI (25%). Anemia and leukocytosis on the third day after bleeding were significantly correlated with the outcome (for anemia: P<.032; confidence interval, 1.12-15.16; odds ratio, 4.12; for leukocytosis: P<.046; confidence interval, 1.03-26.13; odds ratio, 5.18). Anemia and leukocytosis were still statistically significant after adjustment for age, sex, modified Fisher scale, and Hunt-Hess scale. CONCLUSION: The presence of leukocytosis and anemia during the third day after SAH was statistically correlated with the occurrence of DCI.
Subject(s)
Blood Cell Count , Brain Ischemia/diagnosis , Subarachnoid Hemorrhage/complications , Anemia/blood , Anemia/diagnosis , Brain Ischemia/blood , Brain Ischemia/complications , Brain Ischemia/epidemiology , Cerebrovascular Circulation/physiology , Critical Care , Databases, Factual , Female , Humans , Leukocytosis/blood , Leukocytosis/diagnosis , Logistic Models , Male , Middle Aged , Models, Theoretical , Odds Ratio , Ohio/epidemiology , Sensitivity and Specificity , Subarachnoid Hemorrhage/diagnostic imaging , Ultrasonography, Doppler, TranscranialABSTRACT
Neurology is traditionally recognized as primarily an outpatient or consultative specialty, usually attracting candidates whose main focus may not necessarily be the management of complex critically ill patients or the performance of invasive procedures. However, the advent of modern mechanical ventilation and, more recently, effective therapies for the treatment of acute ischemic stroke and other neurologic catastrophes is bringing about a paradigm shift, with neurologists increasingly assuming a more aggressive attitude and rapid response to frequently disabling and often fatal pathologies.
