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Published on: August 30, 2020
Hematologic Indices and Chronic Subdural Hematoma: A Single-Center Cohort Study
Hrvoje Barić1,2, Sara Komljenović3, Katarina Bilić3
1Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia.
Insights
Hematologic and inflammatory markers like red cell distribution width (RDW), systemic immune-inflammatory index (SII), and platelet-to-lymphocyte ratio (PLR) show prognostic potential in chronic subdural hematoma (cSDH) management. These markers can aid in diagnosing and predicting outcomes for cSDH patients.
Area of Science:
- Neurosurgery
- Neurology
- Inflammation Research
Background:
- Chronic subdural hematoma (cSDH) is a prevalent condition, particularly in the elderly, with significant recurrence rates and potential for severe complications.
- Inflammation is recognized as a key factor in cSDH pathogenesis, and laboratory markers have shown utility as prognostic indicators.
- Identifying reliable markers for cSDH management is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the role of hematologic and inflammatory markers in the diagnosis and prognosis of chronic subdural hematoma (cSDH).
- To compare these markers between different cSDH thickness groups to identify potential predictive values.
- To assess the association of these markers with patient outcomes, including Glasgow Outcome Score (GOS), mortality, and recurrence.
Main Methods:
- A retrospective review of 72 patients with cSDH treated between 2018 and 2020 was conducted.
- Data collected included patient demographics, clinical factors (GCS, anticoagulants), laboratory markers (leukocyte, neutrophil, platelet, CRP, hemoglobin, RDW, neutrophil-to-lymphocyte ratio, PLR, SII), cSDH characteristics (size, midline shift), and treatment details.
- Hematologic and inflammatory indices were compared between cSDH groups stratified by thickness (15 mm threshold).
Main Results:
- Patients (median age 77) with cSDH often had comorbidities and received anticoagulant treatment.
- Significant differences in white blood cell count, red cell distribution width (RDW), systemic immune-inflammatory index (SII), and platelet-to-lymphocyte ratio (PLR) were observed between cSDH thickness groups (p < 0.05).
- The study noted a 27.8% recurrence rate and 25% reoperation rate within one year, with 11.1% mortality.
Conclusions:
- Hematologic indices, including RDW, SII, and PLR, demonstrate significant diagnostic and prognostic value in the management of chronic subdural hematoma.
- These laboratory markers may aid clinicians in assessing disease severity and predicting outcomes in cSDH patients.
- Further research into these markers could refine treatment strategies and improve patient care for cSDH.
Abstract:
Objective Chronic subdural hematoma (cSDH) is common, predominantly affects the elderly, often recurs after treatment, and can have serious complications, including death. Inflammation plays an important role in cSDH and it has been previously shown that some laboratory indices are useful as prognostic markers. The aim was to research the role of hematologic and inflammatory markers in cSDH. Materials and Methods A single-center archival database review to retrieve data on cSDH cases operated on between 2018 and 2020, including: (1) sociodemography (age, gender), (2) clinics (Glasgow Coma Score [GCS], anticoagulants, chronic conditions), (3) laboratory (leukocyte, neutrophil, platelet, C-reactive protein, hemoglobin, red cell distribution width [RDW], neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio [PLR], systemic immune-inflammatory index [SII]), (4) cSDH (size, location, midline shift), and (5) treatment (craniotomy/craniostomy, drainage). Primary outcome was Glasgow Outcome Score (GOS) at discharge and at 1 year, and secondary outcomes were 1 year mortality, resurgery, and recurrence. Hematological and inflammatory indices were compared across two cSDH thickness groups. Results Seventy-two patients were included, 25 women and 47 men, median age 77 years. Seventeen (23.6%) patients had chronic anticoagulant treatment. The majority had a chronic comorbidity: 19 (26.4%) diabetes, 48 (66.7%) hypertension, and 56 (77.8%) other chronic diseases. Median preoperative GCS was 15. Median cSDH thickness was 22.9 mm, sidedness was equally distributed, and midline shift occurred in 60 (83.3 %) patients, with median midline shift of 8.4 mm. The majority of patients underwent a single craniostomy ( n = 44, 61.1%), and in all patients a subdural drainage was placed. Median GOS at discharge and at 1 year postoperatively was 5. Mortality was 11.1%, and 16.7% of patients were lost to follow-up. Within the 1-year follow-up, 27.8% of patients had disease recurrence, 25% underwent a repeat surgery. In the "above" versus "below" 15 mm cSDH thickness group there were significant differences in P count (211.5 vs. 279.5 × 10 9 /L, p = 0.009), RDW (13.3 vs. 12.6, p = 0.031), SII (1782 vs. 2653, p = 0.025), and PLR (26.2 vs. 36.7, p = 0.042). Conclusion Hematological indices bear a diagnostic and prognostic potential in cSDH management.
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