Bappaditya Ray1, Stephen R Ross2, Gopichand Danala3, Faranak Aghaei3, Claire Delpirou Nouh2, Lance Ford4, Kimberly M Hollabaugh4, Brittany N Karfonta2, Joshua A Santucci2, Benjamin O Cornwell5, Bradley N Bohnstedt6, Bin Zheng3, George L Dale7, Calin I Prodan2. 1. Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: Bappaditya-Ray@ouhsc.edu. 2. Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 3. Electrical Engineering, University of Oklahoma, Norman, OK, USA. 4. Biostatistics & Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 5. Radiology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 6. Neurosurgery, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 7. Internal Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Abstract
PURPOSE: Post-hemorrhage period after aneurysmal subarachnoid hemorrhage (aSAH) has several systemic manifestations including prothrombotic and pro-inflammatory states. Inter-relationship between these states using established/routine laboratory biomarkers and its long-term effect on clinical outcome is not well-defined. MATERIALS AND METHODS: Retrospective analysis of prospective cohort of 44 aSAH patients. Trend of procoagulant biomarkers [coated-platelets, mean platelet volume to platelet count (MPV:PLT)] and peripheral inflammatory biomarkers [platelet-lymphocyte ratio (PLR), neutrophil-platelet ratio (NLR)] were analyzed using regression analysis. Occurrence of delayed cerebral ischemia (DCI), modified Rankin score (mRS) of 3-6 and Montreal cognitive assessment (MoCA) of <26 at 1-year defined adverse clinical outcome. RESULTS: Patients with worse mRS and MoCA score had higher rise in coated-platelet compared to those with better scores [20.4 (IQR: 15.6, 32.9) vs. 10.95 (IQR: 6.1, 18.9), p = 0.003] and [16.9 (IQR: 13.4, 28.1) vs. 10.95 (IQR: 6.35, 18.65), p = 0.02] respectively. NLR and PLR trends showed significant initial decline followed by a gradual rise in NLR among those without DCI as compared to persistent low levels in those developing DCI (0.13 units/day vs. -0.07 units/day, p = 0.06). CONCLUSIONS: Coated-platelet rise after aSAH is associated with adverse long-term clinical outcome. NLR and PLR trends show an early immune-depressed state after aSAH.
PURPOSE: Post-hemorrhage period after aneurysmal subarachnoid hemorrhage (aSAH) has several systemic manifestations including prothrombotic and pro-inflammatory states. Inter-relationship between these states using established/routine laboratory biomarkers and its long-term effect on clinical outcome is not well-defined. MATERIALS AND METHODS: Retrospective analysis of prospective cohort of 44 aSAH patients. Trend of procoagulant biomarkers [coated-platelets, mean platelet volume to platelet count (MPV:PLT)] and peripheral inflammatory biomarkers [platelet-lymphocyte ratio (PLR), neutrophil-platelet ratio (NLR)] were analyzed using regression analysis. Occurrence of delayed cerebral ischemia (DCI), modified Rankin score (mRS) of 3-6 and Montreal cognitive assessment (MoCA) of <26 at 1-year defined adverse clinical outcome. RESULTS:Patients with worse mRS and MoCA score had higher rise in coated-platelet compared to those with better scores [20.4 (IQR: 15.6, 32.9) vs. 10.95 (IQR: 6.1, 18.9), p = 0.003] and [16.9 (IQR: 13.4, 28.1) vs. 10.95 (IQR: 6.35, 18.65), p = 0.02] respectively. NLR and PLR trends showed significant initial decline followed by a gradual rise in NLR among those without DCI as compared to persistent low levels in those developing DCI (0.13 units/day vs. -0.07 units/day, p = 0.06). CONCLUSIONS:Coated-platelet rise after aSAH is associated with adverse long-term clinical outcome. NLR and PLR trends show an early immune-depressed state after aSAH.
Authors: Gopichandh Danala; Masoom Desai; Bappaditya Ray; Morteza Heidari; Sai Kiran R Maryada; Calin I Prodan; Bin Zheng Journal: Ann Biomed Eng Date: 2022-02-02 Impact factor: 3.934