Hematologic and Inflammatory Predictors of Outcome in Patients with Brain Arteriovenous Malformations

Authors

Stefan W. Koester, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Brandon K. Hoglund, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Olga Ciobanu-Caraus, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Joelle N. Hartke, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Mark A. Pacult, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Ethan A. Winkler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@barrowneuro.org.

Document Type

Article

Abstract

OBJECTIVE: This study investigated the prognostic value of admission blood counts for arteriovenous malformation (AVM) outcomes and compared admission blood counts for patients with ruptured and unruptured AVMs. METHODS: A retrospective analysis of patients who underwent surgical treatment for a ruptured cerebral AVM between February 1, 2014, and March 31, 2020, was conducted. The primary outcome was poor neurologic outcome, defined as a modified Rankin Scale score ≥2 in patients with unruptured AVMs or >2 in patients with ruptured AVMs. RESULTS: Of 235 included patients, 80 (34%) had ruptured AVMs. At admission, patients with ruptured AVMs had a significantly lower mean (SD) hemoglobin level (12.78 [2.07] g/dL vs. 13.71 [1.60] g/dL, P < 0.001), hematocrit (38.1% [5.9%] vs. 40.7% [4.6%], P < 0.001), lymphocyte count (16% [11%] vs. 26% [10%], P < 0.001), and absolute lymphocyte count (1.41 [0.72] × 10/μL vs. 1.79 [0.68] × 10/μL, P < 0.001), and they had a significantly higher mean (SD) white blood cell count (10.4 [3.8] × 10/μL vs. 7.6 [2.3] × 10/μL, P < 0.001), absolute neutrophil count (7.8 [3.8] × 10/μL vs. 5.0 [2.5] × 10/μL, P < 0.001), and neutrophil count (74% [14%] vs. 64% [13%], P < 0.001). Among patients with unruptured AVMs, white blood cell count ≥6.4 × 10/μL and absolute neutrophil count ≥3.4 × 10/μL were associated with a favorable neurologic outcome, whereas hemoglobin level ≥13.4 g/dL was associated with an unfavorable outcome. Among patients with ruptured AVMs, hypertension was associated with a 3-fold increase in odds of a poor neurologic outcome. CONCLUSIONS: Patients with ruptured and unruptured AVMs present with characteristic profiles of hematologic and inflammatory parameters evident in their admission blood work.

Medical Subject Headings

Humans; Female; Male; Intracranial Arteriovenous Malformations (surgery, blood, complications); Retrospective Studies; Middle Aged; Adult; Prognosis; Treatment Outcome; Aged

Publication Date

5-1-2024

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

185

First Page

e342

Last Page

e350

PubMed ID

38340796

Digital Object Identifier (DOI)

10.1016/j.wneu.2024.02.001

Recommended Citation

Koester, Stefan W.; Hoglund, Brandon K.; Ciobanu-Caraus, Olga; Hartke, Joelle N.; Pacult, Mark A.; Winkler, Ethan A.; Catapano, Joshua S.; and Lawton, Michael T., "Hematologic and Inflammatory Predictors of Outcome in Patients with Brain Arteriovenous Malformations" (2024). Neurosurgery. 2002.
https://scholar.barrowneuro.org/neurosurgery/2002