Medical Student Vanderbilt University School of Medicine Nashville, Tennessee, United States
Introduction: The current literature indicates that inflammatory processes play a crucial role in the formation and progression of arteriovenous malformation (AVMs). Thus, the investigation of clinical markers for the inflammatory state of patients with AVM on clinical outcomes is warranted. Herein, the prognostic value of admission blood counts for AVM outcomes is investigated.
Methods: The authors retrospectively analyzed patients who underwent surgical treatment for a ruptured cerebral AVM between 2/2014 to 3/2020. Inclusion criteria included the availability of admission bloodwork. The primary outcome was poor neurologic outcome as defined by mRS >/= 2 in unruptured AVMs and mRS > 2 in ruptured AVMs. Optimal cutoff points for continuous variables were determined using Euclidean distance analysis maximizing the specificity and sensitivity onto outcome.
Results: A total of 235 patients are included in the analysis. The ruptured cohort was found to have significantly lower hemoglobin (Hb) (12.78 (2.07) vs 13.71 (1.60)), hematocrit (38.1 (5.9) vs 40.7 (4.6)), and absolute lymphocyte counts (16 (11) vs 26 (10); 1.41 (0.72) vs 1.79 (0.68); all p < 0.001) upon admission (Table 1). The ruptured cohort was also found to have higher white blood cell counts (WBC) (10.4 (3.8) vs 7.6 (2.3)), absolute neutrophil count (ANC) (7.8 (3.8) vs 5.0 (2.5)), and neutrophil counts (74 (14) vs 64 (13); all p < 0.001) on admission. Within the unruptured cohort, WBC >/= 6.4 and ANC >/= 3.4 lowered the odds, whereas Hb >/= 13.4 increased the odds lower odds of having an unfavorable neurological outcome (Table 5). In the ruptured cohort, hypertension was associated with a three-fold increase in the odds of poor neurological outcome.
Conclusion : This study demonstrates that patients with ruptured AVMs and unruptured AVMs present with characteristic hematologic profiles. Furthermore, the authors demonstrate hematologic and inflammatory markers for increased risk of worse neurological outcomes.
