PDF(Pubmed)
Abstract：
UNASSIGNED: White blood cell (WBC) counts has been identified as a prognostic biomarker which frequently predict adverse outcomes and mortality risk in various conditions. However, evidence for the association between WBC counts and short-term outcomes after intracranial tumor resection remains limited. This study aimed to explore associations between preoperative WBC counts and thirty-day surgical mortality after craniotomy in adult intracranial tumor patients.
UNASSIGNED: This retrospective cohort study performed secondary analysis of 18,049 intracranial tumor craniotomy patients from the ACS NSQIP database (2012-2015). The major exposure and outcome were preoperative WBC counts and thirty-day surgical mortality, respectively. Cox regression modeling assessed the linear association between them. Non-linear associations between them were evaluated by conducting smooth curve fitting using an additive Cox proportional hazard model in conjunction with segmented linear regression modeling. Subgroup analysis and interaction testing assessed effect modification. Sensitivity analysis evaluated result robustness.
UNASSIGNED: The total thirty-day surgical mortality after craniotomy was 2.49% (450/18,049). The mean of preoperative WBC counts was 9.501 ± 4.402 × 10^9/L. Fully adjusted model shows that elevated preoperative WBC counts was independently associated with increased thirty-day surgical mortality (HR = 1.057, 95%CI: 1.040, 1.076). Further analysis revealed a non-linear association between them: below a WBC threshold of 13.6 × 10^9/L, higher WBC counts elevated thirty-day mortality (HR = 1.117; 95%CI: 1.077, 1.158), while risk plateaued and no significant mortality rise occurred above this level (HR = 1.015, 95%CI: 0.982, 1.050). Steroid usage status has a significant effect modification on the WBC-mortality association (P for interaction = 0.002). The non-linear WBC-mortality association was only present for non-steroid users (HR = 1.158, 95%CI: 1.108, 1.210) but not steroid users (HR = 1.009, 95%CI: 0.966, 1.055). The sensitivity analysis confirmed the result robustness.
UNASSIGNED: Elevated preoperative WBC counts were independently and non-linearly associated with an increased risk of thirty-day surgical mortality in adult non-steroid use patients undergoing craniotomy for intracranial tumors. As a convenient predictor, preoperative WBC data allows improved risk profiling and personalized management in adult intracranial tumor patients.
UNASSIGNED: This retrospective cohort study performed secondary analysis of 18,049 intracranial tumor craniotomy patients from the ACS NSQIP database (2012-2015). The major exposure and outcome were preoperative WBC counts and thirty-day surgical mortality, respectively. Cox regression modeling assessed the linear association between them. Non-linear associations between them were evaluated by conducting smooth curve fitting using an additive Cox proportional hazard model in conjunction with segmented linear regression modeling. Subgroup analysis and interaction testing assessed effect modification. Sensitivity analysis evaluated result robustness.
UNASSIGNED: The total thirty-day surgical mortality after craniotomy was 2.49% (450/18,049). The mean of preoperative WBC counts was 9.501 ± 4.402 × 10^9/L. Fully adjusted model shows that elevated preoperative WBC counts was independently associated with increased thirty-day surgical mortality (HR = 1.057, 95%CI: 1.040, 1.076). Further analysis revealed a non-linear association between them: below a WBC threshold of 13.6 × 10^9/L, higher WBC counts elevated thirty-day mortality (HR = 1.117; 95%CI: 1.077, 1.158), while risk plateaued and no significant mortality rise occurred above this level (HR = 1.015, 95%CI: 0.982, 1.050). Steroid usage status has a significant effect modification on the WBC-mortality association (P for interaction = 0.002). The non-linear WBC-mortality association was only present for non-steroid users (HR = 1.158, 95%CI: 1.108, 1.210) but not steroid users (HR = 1.009, 95%CI: 0.966, 1.055). The sensitivity analysis confirmed the result robustness.
UNASSIGNED: Elevated preoperative WBC counts were independently and non-linearly associated with an increased risk of thirty-day surgical mortality in adult non-steroid use patients undergoing craniotomy for intracranial tumors. As a convenient predictor, preoperative WBC data allows improved risk profiling and personalized management in adult intracranial tumor patients.
摘要：
■白细胞（WBC）计数已被确定为预后生物标志物，其经常预测各种情况下的不良后果和死亡风险。然而,WBC计数与颅内肿瘤切除术后短期结局之间的相关性的证据仍然有限.本研究旨在探讨成人颅内肿瘤患者术前白细胞计数与开颅手术后30天手术死亡率之间的关系。
■这项回顾性队列研究对ACSNSQIP数据库（2012-2015）中的18,049例颅内肿瘤开颅手术患者进行了二次分析。主要暴露和结果为术前白细胞计数和30天手术死亡率。分别。Cox回归模型评估了它们之间的线性关联。通过使用加性Cox比例风险模型结合分段线性回归模型进行平滑曲线拟合来评估它们之间的非线性关联。亚组分析和相互作用测试评估了效果修改。敏感性分析评估了结果的稳健性。
■开颅手术后30天的总死亡率为2.49%(450/18,049)。术前白细胞计数平均值为9.501±4.402×10^9/L完全校正模型显示术前白细胞计数升高与30天手术死亡率升高独立相关(HR=1.057,95CI:1.040,1.076)。进一步分析揭示了它们之间的非线性关联：低于13.6×10^9/L的WBC阈值，白细胞计数较高，30天死亡率升高（HR=1.117；95CI：1.077，1.158），而风险趋于稳定，死亡率没有明显上升（HR=1.015，95CI：0.982，1.050）。类固醇使用状态对WBC-死亡率关联具有显著影响(相互作用的P=0.002)。非线性WBC-死亡率关联仅存在于非类固醇使用者(HR=1.158,95CI:1.108,1.210),而不是类固醇使用者(HR=1.009,95CI:0.966,1.055)。灵敏度分析证实了结果的稳健性。
■术前白细胞计数升高与接受颅内肿瘤开颅手术的成人非类固醇治疗患者30天手术死亡率风险增加独立且非线性相关。作为一个方便的预测器，术前WBC数据可以改善成人颅内肿瘤患者的风险分析和个性化管理.
■这项回顾性队列研究对ACSNSQIP数据库（2012-2015）中的18,049例颅内肿瘤开颅手术患者进行了二次分析。主要暴露和结果为术前白细胞计数和30天手术死亡率。分别。Cox回归模型评估了它们之间的线性关联。通过使用加性Cox比例风险模型结合分段线性回归模型进行平滑曲线拟合来评估它们之间的非线性关联。亚组分析和相互作用测试评估了效果修改。敏感性分析评估了结果的稳健性。
■开颅手术后30天的总死亡率为2.49%(450/18,049)。术前白细胞计数平均值为9.501±4.402×10^9/L完全校正模型显示术前白细胞计数升高与30天手术死亡率升高独立相关(HR=1.057,95CI:1.040,1.076)。进一步分析揭示了它们之间的非线性关联：低于13.6×10^9/L的WBC阈值，白细胞计数较高，30天死亡率升高（HR=1.117；95CI：1.077，1.158），而风险趋于稳定，死亡率没有明显上升（HR=1.015，95CI：0.982，1.050）。类固醇使用状态对WBC-死亡率关联具有显著影响(相互作用的P=0.002)。非线性WBC-死亡率关联仅存在于非类固醇使用者(HR=1.158,95CI:1.108,1.210),而不是类固醇使用者(HR=1.009,95CI:0.966,1.055)。灵敏度分析证实了结果的稳健性。
■术前白细胞计数升高与接受颅内肿瘤开颅手术的成人非类固醇治疗患者30天手术死亡率风险增加独立且非线性相关。作为一个方便的预测器，术前WBC数据可以改善成人颅内肿瘤患者的风险分析和个性化管理.
