Anevrizmatik subaraknoid kanama sonrası prognostik faktör olarak platelet volüm indeksinin değerlendirilmesi

Yıl 2019, , 685 - 688, 01.09.2019

Tolga Turan Dündar , Serkan Kitiş Anas Abdallah , İsmail Yurtsever Bedia Gülen

https://doi.org/10.28982/josam.567491

Cited By: 3

Öz

Amaç: Anevrizmatik subaraknoid kanama (SAK), acil servislerde görülen şiddetli ve ölümcül bir hastalıktır. Tanı ve tedavi tekniklerinde ki tüm gelişmelere rağmen halen yüksek morbidite ve mortalite oranına sahiptir. Biyokimyasal ve görüntüleme analizlerini içeren bir çok prognostik yöntemler olmasına rağmen, halen ideal bir belirteç mevcut değildir. Anevrizmatik subaraknoid kanamalarda Fisher skalası, beyin bilgisayarlı tomografisi (BT) görüntülerinden elde edilen ve uzun yıllardır güvenle kullanılan bir prognoz göstergesidir. Diğer yandan immün yanıt ise nöronal hasarın dolayısı ile prognozun ana belirleyicisidir. Ortalama platelet hacminin platalet sayımına oranı olan platelet hacim indeksini (PHİ), immün yanıt göstergesi olarak kullanan çalışma sayısı gittikçe artmaktadır. Biz de çalışmamızda immün yanıtın göstergesi olan platalet hacim indeksini, güvenilir bir yöntem olan Fisher skalası ile karşılaştırarak prognoz belirteci olma olasılığını araştırdık.

Yöntemler: Bu retrospektif kohort çalışmaya, acil servise başvuran 52 hasta çalışmaya dahil edildi. Hasta yaşı, cinsiyet, Fisher değeri, rüptüre anevrizmanın lokalizasyonu, PHİ, Glasgow koma değeri (GKS) ile çalışma kartı oluşturuldu. PHİ’i ortalama platalet volümü (fL) x100 / platalet sayısı (per 1000) olarak belirlendi. Tecrübeli nöroradyolojist tarafından, başvuru anındaki BT’e göre Fisher değeri hesaplandı, beyin cerrahisi ve acil tıp doktorları tarafından GKS değeri kayıt edildi. Pearson korelasyon testi, veri analizi amacıyla kullanıldı. 

Bulgular: PHİ’i ile GKS ve Fisher değerleri arasında istatiksel olarak anlamlı ilişki bulundu. Bu sonuç literatür ile uyumluydu. Dahası, PHİ ile Fisher skala değeri arasında istatiksel olarak anlamlı, pozitif yönde bir korelasyon olduğu görüldü. 

Sonuç: PHİ’i SAK’larda prognostik bir belirteç olabilir. Fakat daha fazla hasta sayısı ile yapılan çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Ortalama platalet hacmi, Platalet hacim indeksi, İnflamatuar belirteç, Subaraknoid kanama

Evaluation of the platelet volume index as a prognostic factor after aneurysmal subarachnoid hemorrhage

Öz

Aim: Subarachnoid Hemorrhage (SAH) originating from an intracranial aneurysm is a severe and life-threatening disease, witnessed by physicians in Emergency Departments (ED). Despite the improvements in diagnostic and therapeutic techniques, morbidity and mortality rates of SAH remain high. Several parameters based on biochemical analysis and imaging techniques are used to evaluate the prognosis. However, efforts for identifying an ideal marker have not been successful. For many years, Fisher Grading System, which is based on computerized tomography (CT), has been used as a reliable predictive scale to identify SAH. Besides, the immune response plays an active role in determining neuro-damage after SAH. Recently, Mean platelet volume (MPV) to platelet count (PLT) ratio has become a trend indicator to anticipate the outcome of a patient suffering from SAH. This study aims to determine whether the comparison of the immune response marker [Platelet Volume Index (PVI)] with the Fisher Grading System could be used as a prognostic factor in subarachnoid hemorrhages with ruptured intracranial aneurysms.

Methods: In this retrospective cohort study, 52 patients diagnosed with spontaneous SAH in the ED were included. The patients’ ages, genders, Fisher grades, locations of the ruptured aneurysm, PVI and Glasgow Coma Scale (GCS) scores were recorded. MPV:PLT ratio was defined as MPV value(fL) x100 /PLT (per 1000). Each patient's GCS at the time of their admission to the ED was noted. An experienced radiologist graded their initial CT scans immediately according to the Fisher Grading System. Patients’ GCS scores were noted by the investigators and PVI was calculated. A retrospective review was carried out regarding medical records of age, sex, and other conditions. The Pearson Correlation Coefficient was used in the analysis of the interrelationship.

Results: The correlation among the PVI with GCS and Fisher Grade test was found to be positive statistically correlation. Relevant literature establishes the same result. Additionally, analyses established a significant positive correlation between the Fisher Grading Scale and the PVI among the data of ruptured aneurysms.

Conclusion: The PVI can be used as a prognostic, predictive factor for SAH. Nevertheless, further studies concerning the prognosis of SAH are needed to confirm this hypothesis.

Anahtar Kelimeler

Platelet volume index, Mean platelet volume, Inflammatory markers, Subarachnoid hemorrhage

Kaynakça

• 1. Galea J, Cruickshank G, Teeling JL, Boche D, Garland P, Perry VH. The intrathecal CD163-haptoglobin-hemoglobin scavenging system in subarachnoid hemorrhage. Journal of Neurochemistry. 2012;121:785–92.
• 2. Balik MS, Erkut A, Guvercin Y, KeskinD. Mean Platelet Volume as a Predictive Marker for Inflammatory Reactivation after Total Hip Arthroplasty. Bakırkoy Tıp Dergisi. 2018;14:57-62.
• 3. Wang Y, Liu Y, Li Y, Liu B, Wu P, Xu S, et al. Protective effects of astaxanthin on subarachnoid hemorrhage-induced early brain injury: Reduction of cerebral vasospasm and improvement of neuron survival and mitochondrial function. Acta Histochem. 2019;121:56-63.
• 4. Nakano F, Kawakita F,Liu L, Nakatsuka Y, Nishikawa H, Okada T, et.al. Anti-vasospastic Effects of Epidermal Growth Factor Receptor Inhibitors After Subarachnoid Hemorrhage in Mice. Mol Neurobiol. 2018;1-11.
• 5. Hirashima Y, Hamada H, Kurimoto M, Origasa H, Endo S. Decrease in platelet count as an independent risk factor for symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2005;102:882-7.
• 6. Zhou Y, Jiang Y, Peng Y, Zhang M. The Quantitative and Functional Changes of Postoperative Peripheral Blood Immune Cell Subsets Relate to Prognosis of Patients with Subarachnoid Hemorrhage: A Preliminary Study. World Neurosurgery.2017;206–215.
• 7. Ray B, Tinsley L, Ford L, Thompson DM, Sidorov EV, Bohnstedt BN .Trends of Platelet Volume İndex Predicts Delayed Cerebral Ischemia after Subarachnoid Hemorrhage. World Neurosurg. 2018;624-31.
• 8. Young GB. Encephalopathy of infection and systemic inflammation. J Clin Neurophysiol. 2013;30(5):454-61.
• 9. Chung TS, Joo JY, Lee SK, Chien D, Laub G. Evaluation of cerebral aneurysms with high-resolution MR angiography using a section-interpolation technique: correlation with digital subtraction angiography. AJNR Am J Neuroradiol. 1999;20(2):229-35.
• 10. Oliveira AM, Paiva WS, Figueiredo EG, Oliveira HA, Teixeira MJ. Fisher revised scale for assessment of prognosis in patients with subarachnoid hemorrhage. Arq Neuropsiquiatr. 2011;69(6):910-3.
• 11. Savarraj JP, McGuire MF, Parsha K, Hergenroeder G, Bajgur S, Ahn S, et al. Disruption of thrombo-inflammatory responses and activation of a distinct cytokine cluster after subarachnoid hemorrhage. Cytokine. 2018;334-41.
• 12. Şimşek BK, Özer G. Evaluation of stroke mortality and related risk factors: A single-center cohort study from Gaziantep, Turkey. 2019;(3)3:231-4.
• 13. Lindvall P, Runnerstam M, Birgander R, Koskinen LO. The Fisher grading correlated to outcome in patients with subarachnoid haemorrhage. Br J Neurosurg. 2009;23(2):188-92.
• 14. Foreman PM, Chua MH2, Harrigan MR, Fisher WS, Tubbs RS, Shoja MM, et al. External validation of the Practical Risk Chart for the prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2017;126(5):1530-6.
• 15. Oliveira AM, Paiva WS, Figueiredo EG, Oliveira HA, Teixeira MJ. Fisher revised scale for assessment of prognosis in patients with subarachnoid hemorrhage Arq Neuropsiquiatr 2011;69(6):910-3.
• 16. Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Ishii K, Kushimoto S et al. Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury. J Neurosurg. 2018;5:1-8.
• 17. Bester J, Pretorius E. Effects of IL-1β, IL-6 and IL-8 on erythrocytes, platelets and clot viscoelasticity, Sci. Rep. 2016;1-10.
• 18. Hoeben A, Landuyt B, Highley MS, Wildiers H, Van Oosterom AT, De Bruijn EA. Vascular endothelial growth factor and angiogenesis, Pharmacol Rev. 2004;549–80.
• 19. Oh GH, Chung SP, Park YS, Hong JH, Lee HS, Chung HS, et al. Mean platelet volume to platelet count ratio as a promising predictor of early mortality in severe sepsis. Shock. 2017;47:323-30.
• 20. Kapsoritakis AN, Koukourakis MI, Sfiridaki A, et al. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterol. 2001;96:776-81.
• 21. Frontera JA, Aledort L, Gordon E, Egorova N, Moyle H, Patel A, et al. Early platelet activation, inflammation and acute brain injury after a subarachnoid hemorrhage: a pilot study. J Thromb Haemost. 2012;10:711-3.
• 22. Teo M, Guilfoyle MR, Turner C, Kirkpatrick PJ, et al. What factors determine treatment outcome in aneurysmal subarachnoid haemorrhage in the modern era? – a post-hoc STASH analysis. World Neurosurgery. 2017;270-81.