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. 2023 May 18:14:1180178.
doi: 10.3389/fneur.2023.1180178. eCollection 2023.

Prognostic significance of white blood cell to platelet ratio in delayed cerebral ischemia and long-term clinical outcome after aneurysmal subarachnoid hemorrhage

Wanwan Zhang  1   2 , Yifei Wang  3 , Qingqing Zhang  1   2 , Fandi Hou  4 , Lintao Wang  1   2 , Zhanqiang Zheng  4 , Yong Guo  4 , Zhongcan Chen  4 , Juha Hernesniemi  4 , Guang Feng  1   4 , Jianjun Gu  1   4
Affiliations

Prognostic significance of white blood cell to platelet ratio in delayed cerebral ischemia and long-term clinical outcome after aneurysmal subarachnoid hemorrhage

Wanwan Zhang et al. Front Neurol. .

Abstract

Objectives: The ratio of white blood cell to platelet count (WPR) is considered a promising biomarker in some diseases. However, its prediction of delayed cerebral ischemia (DCI) and prognosis after aneurysmal subarachnoid hemorrhage (aSAH) has not been studied. The primary objective of this study was to investigate the predictive value of WPR in DCI after aSAH and its impact on 90-day functional outcome.

Materials and methods: This study retrospectively analyzed the data of blood biochemical parameters in 447 patients with aSAH at early admission. Univariate and multivariate analyses were used to determine the risk factors for DCI. According to multivariate analysis results, a nomogram for predicting DCI is developed and verified by R software. The influence of WPR on 90-day modified Rankin score (mRS) was also analyzed.

Results: Among 447 patients with aSAH, 117 (26.17%) developed DCI during hospitalization. Multivariate logistic regression analysis showed that WPR [OR = 1.236; 95%CI: 1.058-1.444; p = 0.007] was an independent risk factor for DCI. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of WPR for DCI, and the cut-off value of 5.26 (AUC 0.804, 95% CI: 0.757-0.851, p < 0.001). The ROC curve (AUC 0.875, 95% CI: 0.836-0.913, p < 0.001) and calibration curve (mean absolute error = 0.017) showed that the nomogram had a good predictive ability for the occurrence of DCI. Finally, we also found that high WPR levels at admission were closely associated with poor prognosis.

Conclusion: WPR level at admission is a novel serum marker for DCI and the poor prognosis after aSAH. A nomogram model containing early WPR will be of great value in predicting DCI after aSAH.

Keywords: activating platelet; aneurysmal subarachnoid hemorrhage (aSAH); biomarker; delayed cerebral ischemia (DCI); inflammation; prognosis; white blood cell to platelet ratio (WPR).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study patients.
Figure 2
Figure 2
Comparison of white blood patients without and with DCI after aneurysmal subarachnoid hemorrhage. (mean interquartile range 4.40 [3.28–5.54] vs 7.31 [5.40–9.12]; p < 0.001).
Figure 3
Figure 3
Receiver operating characteristic curve analysis comparing modified Fisher (mFisher) grade, white blood cell to platelet count ratio (WPR), mean platelet volume(MPV), platelet count (PLT)and platelet-large cell ratio(P-LCR)at admission for identifying delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. The area under the curves of mFisher grade, WPR, MPV, PLT and P-LCR were 0.754 (95%CI: 0. 697–0.811), 0.804 (95%CI: 0. 757–0.851), 0.693 (95%CI: 0. 636–0.750), 0.772 (95%CI: 0. 723–0.822), and 0.749 (95% CI, 0.699–0.799).
Figure 4
Figure 4
Nomogram prediction of DCI including modified Fisher grade, MPV, PLT, WPR and P-LCR factors.
Figure 5
Figure 5
The receiver operating characteristic curve and calibration curves of predictive nomogram for delayed cerebral ischemia. (A) The area under the curve is 0.875 (95%CI: 0.836–0.913), indicating that the nomogram has good predictive performance. (B) The average absolute error of the calibration curve is 0.017, indicating high accuracy of the nomogram.
Figure 6
Figure 6
Modified Rankin Scale scores at 3 months in patients with ratio of white blood cell to platelet count (WPR) > 5.26 and WPR ≤ 5.26.
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