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Early Fevers and Elevated Neutrophil-to-Lymphocyte Ratio are Associated with Repeat Endovascular Interventions for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

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Abstract

Background

Patients with aneurysmal subarachnoid hemorrhage (aSAH) may develop refractory arterial cerebral vasospasm requiring multiple endovascular interventions. The aim of our study is to evaluate variables associated with need for repeat endovascular treatments in refractory vasospasm and to identify differences in outcomes following one versus multiple treatments.

Methods

We retrospectively reviewed patients treated for aSAH between 2017 and 2020 at two tertiary care centers. We included patients who underwent treatment (intraarterial infusion of vasodilatory agents or mechanical angioplasty) for radiographically diagnosed vasospasm in our analysis. Patients were divided into those who underwent single treatment versus those who underwent multiple endovascular treatments for vasospasm.

Results

Of the total 418 patients with aSAH, 151 (45.9%) underwent endovascular intervention for vasospasm. Of 151 patients, 95 (62.9%) underwent a single treatment and 56 (37.1%) underwent two or more treatments. Patients were more likely to undergo multiple endovascular treatments if they had a Hunt–Hess score > 2 (odds ratio [OR] 5.10 [95% confidence interval (CI) 1.82–15.84]; p = 0.003), a neutrophil-to-lymphocyte ratio > 8.0 (OR 3.19 [95% CI 1.40–7.62]; p = 0.028), and more than two fevers within the first 5 days of admission (OR 7.03 [95% CI 2.68–20.94]; p < 0.001). Patients with multiple treatments had poorer outcomes, including increased length of stay, delayed cerebral ischemia, in-hospital complications, and higher modified Rankin scores at discharge.

Conclusions

A Hunt–Hess score > 2, a neutrophil-to-lymphocyte ratio > 8.0, and early fevers may be predictive of need for multiple endovascular interventions in refractory cerebral vasospasm after aSAH. These patients have poorer functional outcomes at discharge and higher rates of in-hospital complications.

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Data availability

Data pertaining to this study are available on reasonable request to the corresponding author.

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Funding

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Author notes

  1. Ehsan Dowlati and William Mualem have contributed equally to this study.

Authors and Affiliations

  1. Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA

    Ehsan Dowlati, Daniel R. Felbaum, Samir Sur, Jeffrey C. Mai & Rocco A. Armonda

  2. School of Medicine, Georgetown University, Washington, DC, USA

    William Mualem

  3. Department of Neurosurgery, New York Medical College, Valhalla, NY, USA

    Austin Carpenter

  4. Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA

    Jason J. Chang

  5. Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA

    Daniel R. Felbaum, Samir Sur, Jeffrey C. Mai & Rocco A. Armonda

  6. Department of Radiology, MedStar Washington Hospital Center, Washington, DC, USA

    Ai-Hsi Liu

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  1. Ehsan Dowlati
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Contributions

ED and WM contributed equally to this article. Study design: ED, WM, JJC, RAA. Data acquisition: ED, WM, AC, JJC. Data analysis and interpretation: ED, WM, SS, DRF, JCM, AHL, RAA. Manuscript preparation: ED, WM, AC, JJC. Revision of manuscript for important intellectual content: JCM, DRF, SS, JJC, AHL, RAA. Approval of the final version of the manuscript: all authors.

Corresponding author

Correspondence to Ehsan Dowlati.

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Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this article.

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The authors confirm adherence to ethical guidelines, and ethical approvals were used of informed consent, as appropriate. This study was approved by the Institutional Review Board at Georgetown University (IRB Approval STUDY00003977).

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Dowlati, E., Mualem, W., Carpenter, A. et al. Early Fevers and Elevated Neutrophil-to-Lymphocyte Ratio are Associated with Repeat Endovascular Interventions for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 36, 916–926 (2022). https://doi.org/10.1007/s12028-021-01399-7

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  • DOI: https://doi.org/10.1007/s12028-021-01399-7

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