• Bappaditya Ray, Stephen R Ross, Gopichand Danala, Faranak Aghaei, Claire Delpirou Nouh, Lance Ford, Kimberly M Hollabaugh, Brittany N Karfonta, Joshua A Santucci, Benjamin O Cornwell, Bradley N Bohnstedt, Bin Zheng, George L Dale, and Calin I Prodan.
• Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: Bappaditya-Ray@ouhsc.edu.
• J Crit Care. 2019 Aug 1; 52: 191-9.

PurposePost-hemorrhage period after aneurysmal subarachnoid hemorrhage (aSAH) has several systemic manifestations including prothrombotic and pro-inflammatory states. Inter-relationship between these states using established/routine laboratory biomarkers and its long-term effect on clinical outcome is not well-defined.Materials And MethodsRetrospective analysis of prospective cohort of 44 aSAH patients. Trend of procoagulant biomarkers [coated-platelets, mean platelet volume to platelet count (MPV:PLT)] and peripheral inflammatory biomarkers [platelet-lymphocyte ratio (PLR), neutrophil-platelet ratio (NLR)] were analyzed using regression analysis. Occurrence of delayed cerebral ischemia (DCI), modified Rankin score (mRS) of 3-6 and Montreal cognitive assessment (MoCA) of <26 at 1-year defined adverse clinical outcome.ResultsPatients with worse mRS and MoCA score had higher rise in coated-platelet compared to those with better scores [20.4 (IQR: 15.6, 32.9) vs. 10.95 (IQR: 6.1, 18.9), p = 0.003] and [16.9 (IQR: 13.4, 28.1) vs. 10.95 (IQR: 6.35, 18.65), p = 0.02] respectively. NLR and PLR trends showed significant initial decline followed by a gradual rise in NLR among those without DCI as compared to persistent low levels in those developing DCI (0.13 units/day vs. -0.07 units/day, p = 0.06).ConclusionsCoated-platelet rise after aSAH is associated with adverse long-term clinical outcome. NLR and PLR trends show an early immune-depressed state after aSAH.Copyright © 2019 Elsevier Inc. All rights reserved.

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