Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(04): 735-740
DOI: 10.1055/s-0044-1790237
Original Article

Hematologic Indices and Chronic Subdural Hematoma: A Single-Center Cohort Study

Hrvoje Barić 
1   Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
2   Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
,
Sara Komljenović
3   Zagreb University School of Medicine, Zagreb, Croatia
,
Katarina Bilić
3   Zagreb University School of Medicine, Zagreb, Croatia
,
William Migo
3   Zagreb University School of Medicine, Zagreb, Croatia
,
Julius Mautin Vitowanu 
4   Division of Neurological Surgery, Department of Surgery, Lagos, State University Teaching Hospital, Ikeja, Lagos, Nigeria
,
Andrej Desnica
1   Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
,
Goran Mrak
1   Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective Chronic subdural hematoma (cSDH) is common, predominantly affects the elderly, often recurs after treatment, and can have serious complications, including death. Inflammation plays an important role in cSDH and it has been previously shown that some laboratory indices are useful as prognostic markers. The aim was to research the role of hematologic and inflammatory markers in cSDH.

Materials and Methods A single-center archival database review to retrieve data on cSDH cases operated on between 2018 and 2020, including: (1) sociodemography (age, gender), (2) clinics (Glasgow Coma Score [GCS], anticoagulants, chronic conditions), (3) laboratory (leukocyte, neutrophil, platelet, C-reactive protein, hemoglobin, red cell distribution width [RDW], neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio [PLR], systemic immune-inflammatory index [SII]), (4) cSDH (size, location, midline shift), and (5) treatment (craniotomy/craniostomy, drainage). Primary outcome was Glasgow Outcome Score (GOS) at discharge and at 1 year, and secondary outcomes were 1 year mortality, resurgery, and recurrence. Hematological and inflammatory indices were compared across two cSDH thickness groups.

Results Seventy-two patients were included, 25 women and 47 men, median age 77 years. Seventeen (23.6%) patients had chronic anticoagulant treatment. The majority had a chronic comorbidity: 19 (26.4%) diabetes, 48 (66.7%) hypertension, and 56 (77.8%) other chronic diseases. Median preoperative GCS was 15. Median cSDH thickness was 22.9 mm, sidedness was equally distributed, and midline shift occurred in 60 (83.3 %) patients, with median midline shift of 8.4 mm. The majority of patients underwent a single craniostomy (n = 44, 61.1%), and in all patients a subdural drainage was placed. Median GOS at discharge and at 1 year postoperatively was 5. Mortality was 11.1%, and 16.7% of patients were lost to follow-up. Within the 1-year follow-up, 27.8% of patients had disease recurrence, 25% underwent a repeat surgery. In the “above” versus “below” 15 mm cSDH thickness group there were significant differences in P count (211.5 vs. 279.5 × 109/L, p = 0.009), RDW (13.3 vs. 12.6, p = 0.031), SII (1782 vs. 2653, p = 0.025), and PLR (26.2 vs. 36.7, p = 0.042).

Conclusion Hematological indices bear a diagnostic and prognostic potential in cSDH management.

Keywords

chronic subdural hematoma - inflammation - hematopoiesis - outcome - surgery

Authors' Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by H.B., S.K., and W.M., H.B., S.K., and K.B., and H.B., J.M.V., A.D., and G.M., respectively. The first draft of the manuscript was written by H.B. and W.M. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.


Ethical Approval

The study was approved by the Institutional Review Board.




Publication History

Article published online:
10 September 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Almenawer SA, Farrokhyar F, Hong C. et al. Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg 2014; 259 (03) 449-457
    CrossrefPubMedSearch in Google Scholar
  • 2 Amirjamshidi A, Abouzari M, Eftekhar B. et al. Outcomes and recurrence rates in chronic subdural haematoma. Br J Neurosurg 2007; 21 (03) 272-275
    CrossrefPubMedSearch in Google Scholar
  • 3 Boaro CM, Diefenthäeler LM, Costa GK. et al. Hematological ratios as prognostic indicators in patients with triple-negative breast cancer in southern Brazil. Mastology 2022; 32: 1-8
    CrossrefSearch in Google Scholar
  • 4 Cavallari I, Patti G. Efficacy and safety of oral anticoagulation in elderly patients with atrial fibrillation. Anatol J Cardiol 2018; 19 (01) 67-71
    PubMedSearch in Google Scholar
  • 5 Chen W, Xin S, Xu B. Value research of NLR, PLR, and RDW in prognostic assessment of patients with colorectal cancer. J Healthc Eng 2022; 2022: 7971415
    CrossrefPubMedSearch in Google Scholar
  • 6 Dumont TM, Rughani AI, Goeckes T, Tranmer BI. Chronic subdural hematoma: a sentinel health event. World Neurosurg 2013; 80 (06) 889-892
    CrossrefPubMedSearch in Google Scholar
  • 7 Gaist D, García Rodríguez LA, Hellfritzsch M. et al. Association of antithrombotic drug use with subdural hematoma risk. JAMA 2017; 317 (08) 836-846
    CrossrefPubMedSearch in Google Scholar
  • 8 Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005; 107 (03) 223-229
    CrossrefPubMedSearch in Google Scholar
  • 9 Hellwig D, Kuhn TJ, Bauer BL, List-Hellwig E. Endoscopic treatment of septated chronic subdural hematoma. Surg Neurol 1996; 45 (03) 272-277
    CrossrefPubMedSearch in Google Scholar
  • 10 Huang J, Zhang Q, Wang R. et al. Systemic immune-inflammatory index predicts clinical outcomes for elderly patients with acute myocardial infarction receiving percutaneous coronary intervention. Med Sci Monit 2019; 25: 9690-9701
    CrossrefPubMedSearch in Google Scholar
  • 11 Idowu OE, Oyeleke SO, Vitowanu JM. Impact of inflammatory cell ratio, biomarkers, activated partial thromboplastin time and prothrombin time on chronic subdural haematoma severity and outcome. Eur J Trauma Emerg Surg 2022; 48 (02) 1085-1092
    CrossrefPubMedSearch in Google Scholar
  • 12 Jabłońska I, Miszczyk M, Goławski M, Dębosz-Suwińska I, Suwiński R. The prognostic value of RDW, NLR and PLR in sequential radio-chemotherapy for advanced lung cancer. Nowotwory J Oncol 2022; 72 (03) 161-166
    CrossrefSearch in Google Scholar
  • 13 Kwon CS, Al-Awar O, Richards O, Izu A, Lengvenis G. Predicting prognosis of patients with chronic subdural hematoma: a new scoring system. World Neurosurg 2018; 109: e707-e714
    CrossrefPubMedSearch in Google Scholar
  • 14 Li M, Xia H, Zheng H. et al. Red blood cell distribution width and platelet counts are independent prognostic factors and improve the predictive ability of IPI score in diffuse large B-cell lymphoma patients. BMC Cancer 2019; 19 (01) 1084
    CrossrefPubMedSearch in Google Scholar
  • 15 López-Verdugo F, Furuzawa-Carballeda J, Romero-Hernández F. et al. Hematological indices as indicators of silent inflammation in achalasia patients: a cross-sectional study. Medicine (Baltimore) 2020; 99 (09) e19326
    CrossrefPubMedSearch in Google Scholar
  • 16 Lund J, Saunders CL, Edwards D, Mant J. Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study. Open Heart 2021; 8 (02) e001737
    CrossrefPubMedSearch in Google Scholar
  • 17 Dobran M, Carrassi E, Di Rienzo A. et al. Preoperative neutrophil to lymphocyte ratio as a predictor of chronic subdural hematoma recurrence. Interdiscip Neurosurg 2022; 28: 101436
    CrossrefSearch in Google Scholar
  • 18 Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg 2011; 114 (01) 72-76
    CrossrefPubMedSearch in Google Scholar
  • 19 Mondorf Y, Abu-Owaimer M, Gaab MR, Oertel JM. Chronic subdural hematoma–craniotomy versus burr hole trepanation. Br J Neurosurg 2009; 23 (06) 612-616
    CrossrefPubMedSearch in Google Scholar
  • 20 Mrak G, Korent V, Mišir Krpan A. et al. Malignant brain neoplasms incidence and mortality trends in Croatia from 2001 to 2014. Croat Med J 2019; 60 (01) 33-41
    CrossrefPubMedSearch in Google Scholar
  • 21 Ng WW, Lam SM, Yan WW, Shum HP. NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit. Sci Rep 2022; 12 (01) 15974
    CrossrefPubMedSearch in Google Scholar
  • 22 Posti JP, Luoto TM, Sipilä JOT, Rautava P, Kytö V. Prognosis of patients with operated chronic subdural hematoma. Sci Rep 2022; 12 (01) 7020
    CrossrefPubMedSearch in Google Scholar
  • 23 Regan JM, Worley E, Shelburne C, Pullarkat R, Watson JC. Burr hole washout versus craniotomy for chronic subdural hematoma: patient outcome and cost analysis. PLoS One 2015; 10 (01) e0115085
    CrossrefPubMedSearch in Google Scholar
  • 24 Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015; 52 (02) 86-105
    CrossrefPubMedSearch in Google Scholar
  • 25 Song DH, Kim YS, Chun HJ. et al. The predicting factors for recurrence of chronic subdural hematoma treated with burr hole and drainage. Korean J Neurotrauma 2014; 10 (02) 41-48
    CrossrefPubMedSearch in Google Scholar
  • 26 Staniewska E, Tomasik B, Tarnawski R, Łaszczych M, Miszczyk M. The prognostic value of red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in radiotherapy for oropharyngeal cancer. Rep Pract Oncol Radiother 2021; 26 (06) 1010-1018
    CrossrefPubMedSearch in Google Scholar
  • 27 Szczygielski J, Gund SM, Schwerdtfeger K, Steudel WI, Oertel J. Factors affecting outcome in treatment of chronic subdural hematoma in ICU patients: impact of anticoagulation. World Neurosurg 2016; 92: 426-433
    CrossrefPubMedSearch in Google Scholar
  • 28 Tran J, Norton R, Conrad N. et al. Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: a population-based cohort study. PLoS Med 2018; 15 (03) e1002513
    CrossrefPubMedSearch in Google Scholar
  • 29 Uddin S, Wang S, Khan A, Lu H. Comorbidity progression patterns of major chronic diseases: the impact of age, gender and time-window. . Chronic Illn 2022;17423953221087647
  • 30 United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2015. Accessed October 20, 2022 at: http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf
  • 31 Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 2003; 74 (07) 937-943
    CrossrefPubMedSearch in Google Scholar
  • 32 Whitehouse KJ, Jeyaretna DS, Enki DG, Whitfield PC. Head injury in the elderly: what are the outcomes of neurosurgical care?. World Neurosurg 2016; 94: 493-500
    CrossrefPubMedSearch in Google Scholar
  • 33 Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am 2017; 28 (02) 205-210
    CrossrefPubMedSearch in Google Scholar
  • 34 Zhang Y, Yang Y, Long S, Li G. Assessment of peripheral blood cell inflammatory markers in patients with chronic subdural hematoma. Clin Neurol Neurosurg 2020; 191: 105738
    CrossrefPubMedSearch in Google Scholar