Correlation between Symptomatic Vasospasm and Leukocyte, Platelet Count Following Aneurysmal Subarachnoid Hemorrhage: Clinical Research

Choi, Jeong Hoon; Moon, Jae Gon; Lee, Ho Kook; Hwang, Do Yun; Kim, Chang Hyun; Choi, Jong Hun

Abstract

OBJECTIVE
The mechanisms of vasospasm after subarachnoid hemorrhage (SAH) are still poorly understood. In recent studies, many authors have suggested that platelet aggregation and consumption within the cerebral vessels after SAH is one of the mechanisms of vasospasm. Some authors reported that leukocytosis is a predictive factor of vasospasm. Therefore, we analyzed fever and the leukocyte and platelet counts in patients with aneurismal SAH. Through this analysis, we tried to investigate the predictive factors of symptomatic vasospasm.
METHODS
We studied 130 patients who had undergone an aneurysmal neck clipping operation or Guglielmi detachable coil (GDC) embolization within 48 hours after the onset of SAH. Age, gender, hypertension, a history of cerebrovascular accident, aneurysm location, Fisher grade, Hunt-Hess classification, Glasgow coma scale, Glasgow outcome scale, fever, leukocyte, platelet count and the radiologic finding were retrospectively analyzed for both the patients with aneurysmal neck clipping and those with endovascular intervention.
RESULTS
One hundred thirty patients were treated for aneurysmal SAH during the review period. Forty nine patients (37.7%) developed symptomatic vasospasm. Symptomatic vasospasm occurred 5.7 days after aneurysmal SAH. During the early hospital period, the Fisher grade (P=0.018), fever (>37.5 degrees C, P=0.029), progressive leukocytosis (WBC>15,000/mm3, P=0.027) and the ratio of thrombocytopenia (platelet count in the hospital/platelet count on admission < or = 0.67, P=0.020) were statistically significant predictors of symptomatic vasospasm. Among these predictive factors, fever (>37.5 degrees C, odd ratio (OR): 4.022, 95% confidence interval (CI): 1.022-6.866), progressive leukocytosis (WBC>15,000/mm3, OR: 8.182, 95% CI: 1.624-13.417) and the ratio of thrombocytopenia (platelet count in hospital/platelet count on admission < or = 0.67, OR: 11.851, 95% CI: 2.311-21.161) were independent predictors of symptomatic vasospasm on multivariated analysis.
CONCLUSION
These results indicated that the Fisher grade, fever and daily monitoring of the leukocyte and platelet counts were important for predicting symptomatic vasospasm after aneurysmal SAH. Especially, fever, leukocytosis and a low platelet count were independent predictors.