Abstract Details

Title Early uptrending white blood cell count can be a predictor of poor outcome in patients with aneurysmal subarachnoid hemorrhage

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-041

Objective To study the significance of early uptrending WBC as a potential predictor for poor outcome is not clear.

Background Increasing white blood cell count (WBC) early in the course of aneurysmal subarachnoid hemorrhage (aSAH) can indicate an ongoing inflammatory process triggered by the initial insult.

Design/Methods A retrospective cohort study from the aSAH database of a tertiary referral academic center of patients admitted from 2015 until 2018 was performed. The WBC on a daily basis for the first 5 days of hospitalization, Hunt and Hess (HH) grade and clinical data including modified Rankin Scale (mRS) at the time of discharge were retrieved. Uptrending WBC was defined as any increase of WBC from admission without any decline within first five days of hospitalization. Leukocytosis was defined as WBC on admission greater than 12,000 cells per microliter. Poor outcome was defined as mRS of 4 to 6 at the time of discharge. The association between uptrending WBC and poor outcome was determined in a multivariate logistic regression model.

Results A total of 183 patients with complete hospitalization data were included. The rate of poor outcome rate was 58% (43/74) in patients with uptrending WBC and 48% (53/109) in patients without uptrending WBC. Of patients with poor outcome, 61% (69/112) had leukocytosis within 24 hours of admission. On a secondary analysis of patients with leukocytosis, 80% (53/66) of patients with initial WBC greater than 15,000 had poor outcome. Early uptrending WBC was significantly associated with poor outcome on multivariate analysis and it was independent of HH grade and leukocytosis on admission (odds ratio=2.36, [95% CI 1.12-4.96]; p=0.023).

Conclusions Uptrending WBC early course of hospitalization can be an independent predictor of poor outcome in patients with aSAH. Further investigations to explore treatment modalities targeting neuro-inflammation in patients with SAH should be sought.

Authors/Disclosures
Aidan Azher, MD (UTHealth, McGovern School of Medicine) PRESENTER	Dr. Azher has nothing to disclose.
Robert Riggio, MD	No disclosure on file
Ashutosh Kaushal, MD (UTHealth Neurosciences – Department of Neurology)	No disclosure on file
	No disclosure on file
Scott Moody	No disclosure on file
	No disclosure on file
Katarina B. Dakay, DO	No disclosure on file
Bradford B. Thompson, MD (St. Elizabeth’s Medical Center)	Dr. Thompson has nothing to disclose.
Michael Reznik, MD (Rhode Island Hospital)	Dr. Reznik has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Morrison Mahoney. The institution of Dr. Reznik has received research support from NIDUS.
Linda C. Wendell, MD, FAAN (Mount Auburn Hospital)	Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. An immediate family member of Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Wendell has stock in Apple. An immediate family member of Dr. Wendell has stock in Apple.
Nicholas S. Potter, MD, PhD (Rhode Island Hospital)	Dr. Potter has nothing to disclose.
Shyam S. Rao, MD (Rhode Island Hospital, Brown University)	No disclosure on file
Shadi Yaghi, MD (Hackensack Meridian Health)	Dr. Yaghi has nothing to disclose.
Brian Mac Grory, MB BCh BAO (Duke University School of Medicine)	An immediate family member of Dr. Mac Grory has received personal compensation for serving as an employee of Sanofi. Dr. Mac Grory has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Mac Grory has received research support from National Institutes of Health. The institution of Dr. Mac Grory has received research support from American Heart Association.
Tina M. Burton, MD	Dr. Burton has nothing to disclose.
Shawna M. Cutting, MD, FAAN	The institution of Dr. Cutting has received research support from Genentech.
	No disclosure on file
Mahesh Jayaraman	No disclosure on file
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.

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