Monocyte Count on Admission Is Predictive of Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage

• Published in: Frontiers in surgery Vol. 9; p. 879050
• Main Authors: Cuoco, Joshua A, Guilliams, Evin L, Klein, Brendan J, Witcher, Mark R, Marvin, Eric A, Patel, Biraj M, Entwistle, John J
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 28-04-2022
• Subjects: aneurysmal subarachnoid hemorrhage; hydrocephalus; immune system; monocyte; shunt-dependence; Surgery; immune system; monocyte; shunt-dependence; hydrocephalus; aneurysmal subarachnoid hemorrhage
• ISSN: 2296-875X; 2296-875X
• DOI: 10.3389/fsurg.2022.879050

The authors sought to evaluate whether immunologic counts on admission were associated with shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage. A retrospective analysis of 143 consecutive patients with aneurysmal subarachnoid hemorrhage over a 9-year period was performed. A stepwise algorithm was followed for external ventricular drain weaning and determining the necessity of shunt placement. Data were compared between patients with and without shunt-dependent hydrocephalus. Overall, 11.19% of the cohort developed shunt-dependent hydrocephalus. On multivariate logistic regression analysis, acute hydrocephalus (OR: 61.027, 95% CI: 3.890-957.327;
= 0.003) and monocyte count on admission (OR: 3.362, 95% CI: 1.024-11.037;
= 0.046) were found to be independent predictors for shunt dependence. Receiver operating characteristic curve analysis for the prediction of shunt-dependent hydrocephalus confirmed that monocyte count exhibited an acceptable area under the curve (AUC = 0.737, 95% CI: 0.601-0.872;
< 0.001). The best predictive cutoff value to discriminate between successful external ventricular drain weaning and shunt-dependent hydrocephalus was identified as a monocyte count ≥0.80 × 10
/uL at initial presentation. These preliminary data demonstrate that a monocyte count ≥0.80 × 10
/uL at admission predicts shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage; however, further large-scale prospective trials and validation are necessary to confirm these findings.