Abstract：
OBJECTIVE: White blood cells (WBC) play an important role in the inflammatory response of the body. Elevated WBC counts on admission in patients with subarachnoid hemorrhage (SAH) correlate with a poor prognosis. However, the role of longitudinal WBC trajectories based on repeated WBC measurements during hospitalization remains unclear. We explored the association between different WBC trajectory patterns and in-hospital mortality.
METHODS: We analyzed a cohort of consecutive patients with SAH between 2012 and 2020. Group-based trajectory modeling (GBTM) was used to group the patients according to their white blood cell patterns over the first 4 days. Stabilized inverse probability treatment weighting (sIPTW) was used to balance baseline demographic and clinical characteristics. We analyzed the association between the WBC trajectory groups and in-hospital mortality using a Cox proportional hazards model.
RESULTS: In total, 506 patients with SAH were included in this retrospective cohort. The final model identified two distinct longitudinal WBC trajectories. After adjusting for confounding factors, multivariate regression analysis suggested that an elevated longitudinal WBC trajectory increased the risk of in-hospital mortality (hazard ratio [HR], 2.476; 95% confidence interval [CI] 1.081-5.227; P = 0.024) before sIPTW, and (HR, 2.472; 95%CI 1.489-4.977; P = 0.018) after sIPTW.
CONCLUSIONS: In patients with SAH, different clinically relevant groups could be identified using WBC trajectory analysis. The WBC count trajectory-initially elevated and then decreased- may lead to an increased risk of in-hospital mortality following SAH.
METHODS: We analyzed a cohort of consecutive patients with SAH between 2012 and 2020. Group-based trajectory modeling (GBTM) was used to group the patients according to their white blood cell patterns over the first 4 days. Stabilized inverse probability treatment weighting (sIPTW) was used to balance baseline demographic and clinical characteristics. We analyzed the association between the WBC trajectory groups and in-hospital mortality using a Cox proportional hazards model.
RESULTS: In total, 506 patients with SAH were included in this retrospective cohort. The final model identified two distinct longitudinal WBC trajectories. After adjusting for confounding factors, multivariate regression analysis suggested that an elevated longitudinal WBC trajectory increased the risk of in-hospital mortality (hazard ratio [HR], 2.476; 95% confidence interval [CI] 1.081-5.227; P = 0.024) before sIPTW, and (HR, 2.472; 95%CI 1.489-4.977; P = 0.018) after sIPTW.
CONCLUSIONS: In patients with SAH, different clinically relevant groups could be identified using WBC trajectory analysis. The WBC count trajectory-initially elevated and then decreased- may lead to an increased risk of in-hospital mortality following SAH.
摘要：
目的：白细胞（WBC）在机体的炎症反应中起重要作用。蛛网膜下腔出血（SAH）患者入院时白细胞计数升高与预后不良相关。然而,住院期间基于反复WBC测量的纵向WBC轨迹的作用尚不清楚.我们探讨了不同WBC轨迹模式与住院死亡率之间的关系。
方法：我们分析了2012年至2020年的连续SAH患者队列。基于组的轨迹建模（GBTM）用于根据患者在前4天的白细胞模式对患者进行分组。使用稳定的逆概率治疗加权(sIPTW)来平衡基线人口统计学和临床特征。我们使用Cox比例风险模型分析了WBC轨迹组与住院死亡率之间的关系。
结果：总计，506例SAH患者纳入本回顾性队列。最终模型确定了两个不同的纵向WBC轨迹。在调整混杂因素后，多变量回归分析表明，纵向白细胞轨迹升高会增加住院死亡率的风险(风险比[HR]，2.476；95%置信区间[CI]1.081-5.227；P=0.024），和（HR，2.472；95CI1.489-4.977；P=0.018）。
结论：在SAH患者中，不同的临床相关组可以通过WBC轨迹分析进行鉴别.WBC计数轨迹-最初升高然后降低-可能导致SAH后院内死亡的风险增加。
方法：我们分析了2012年至2020年的连续SAH患者队列。基于组的轨迹建模（GBTM）用于根据患者在前4天的白细胞模式对患者进行分组。使用稳定的逆概率治疗加权(sIPTW)来平衡基线人口统计学和临床特征。我们使用Cox比例风险模型分析了WBC轨迹组与住院死亡率之间的关系。
结果：总计，506例SAH患者纳入本回顾性队列。最终模型确定了两个不同的纵向WBC轨迹。在调整混杂因素后，多变量回归分析表明，纵向白细胞轨迹升高会增加住院死亡率的风险(风险比[HR]，2.476；95%置信区间[CI]1.081-5.227；P=0.024），和（HR，2.472；95CI1.489-4.977；P=0.018）。
结论：在SAH患者中，不同的临床相关组可以通过WBC轨迹分析进行鉴别.WBC计数轨迹-最初升高然后降低-可能导致SAH后院内死亡的风险增加。
