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Preoperative elevated eosinophils in peripheral blood for prediction of postoperative recurrence of chronic subdural
Maoki Matsubara1, Kenji Yagi1, Yukari Minami1
1Departments of1Neurosurgery and.
Insights
Elevated preoperative eosinophil counts in peripheral blood are linked to chronic subdural hematoma (CSDH) recurrence. Patients with higher eosinophils require closer monitoring post-surgery for CSDH.
Area of Science:
- Neurosurgery
- Hematology
- Immunology
Background:
- Chronic subdural hematoma (CSDH) presents a significant challenge due to high postoperative recurrence rates.
- While inflammation, angiogenesis, and fibrinolysis are implicated, the role of leukocyte differential counts in CSDH recurrence remains underexplored.
Purpose of the Study:
- To investigate the association between preoperative differential leukocyte counts and the recurrence rate of chronic subdural hematoma (CSDH).
Main Methods:
- A retrospective review of 466 patients (517 CSDHs) who underwent surgery between 2011 and 2021.
- Analysis included preoperative differential blood leukocyte counts, with eosinophil-rich defined as ≥ 100/µL.
- Follow-up was conducted for at least 3 months postoperatively.
Main Results:
- CSDH recurrence was observed in 9.3% of cases.
- Preoperative eosinophil counts were significantly associated with CSDH recurrence (p=0.03).
- Independent predictors of recurrence included thrombocytopenia, anticoagulant use, hematoma volume, and eosinophil-rich peripheral blood (aOR 2.22, p=0.02).
Conclusions:
- Preoperative peripheral blood eosinophil count is an independent risk factor for CSDH recurrence.
- Elevated preoperative eosinophils warrant careful postoperative follow-up for patients with CSDH.
Objective:
Chronic subdural hematoma (CSDH) is a common neurological disease with a significant postoperative recurrence rate. There are numerous reported studies of the development of CSDH. In recent years, fibrinolysis, angiogenesis, and inflammation have all been identified as relevant factors in the development of CSDH. While several authors have reported risk factors associated with CSDH recurrence, differential blood count of leukocytes has not yet been discussed. Therefore, in this study the authors aimed to retrospectively investigate the association between differential blood leukocyte count and the rate of CSDH recurrence.
Methods:
The authors retrospectively reviewed 476 patients with 529 CSDHs who underwent surgery at a single institution between January 2011 and December 2021. After exclusion of patients who had not undergone a differential blood test of leukocytes preoperatively, CSDHs in 517 cerebral hemispheres of 466 patients were included in the study. Peripheral blood eosinophil counts ≥ 100/µL were considered eosinophil rich.
Results:
CSDHs in 494 cerebral hemispheres of 445 patients were followed up postoperatively for at least 3 months or until resolution indicated by CSDH disappearance. Postoperative recurrence of CSDH was observed in 46 cerebral hemispheres (9.3%). Among the preoperative differential blood counts of all leukocytes, eosinophils alone were significantly associated with CSDH recurrence (median [IQR] 76/µL [30-155/µL] vs 119/µL [39-217/µL]; p = 0.03). Multivariable regression analysis showed thrombocytopenia (adjusted OR [aOR] 5.23, 95% CI 1.85-14.79; p = 0.002), use of anticoagulant drugs (aOR 2.51, 95% CI 1.17-5.38; p = 0.02), hematoma volume (10 mL per increase) (aOR 1.08, 95% CI 1.00-1.16; p = 0.04), and eosinophil-rich peripheral blood (aOR 2.22, 95% CI 1.17-4.23; p = 0.02) were all independent predictors for CSDH recurrence.
Conclusions:
This study showed that preoperative peripheral blood eosinophil count was an independent risk factor for CSDH recurrence. Therefore, patients with CSDH who have elevated eosinophils preoperatively in peripheral blood require careful follow-up.
