{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:49:15Z","timestamp":1760147355904,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,28]],"date-time":"2023-01-28T00:00:00Z","timestamp":1674864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>A multitude of pathological and inflammatory processes determine the clinical course after aneurysmal subarachnoid hemorrhage (aSAH). However, our understanding of predictive factors and therapeutic consequences is limited. We evaluated the predictive value of clinically relevant factors readily available in the ICU setting, such as white blood cell (WBC) count and CRP, for two of the leading comorbidities, delayed cerebral ischemia (DCI) and ventriculoperitoneal (VP) shunt dependency in aSAH patients with and without corticosteroid treatment. We conducted a retrospective analysis of 484 aSAH patients admitted to our institution over an eight-year period. Relevant clinical factors affecting the risk of DCI and VP shunt dependency were identified and included in a multivariate logistic regression model. Overall, 233\/484 (48.1%) patients were treated with corticosteroids. Intriguingly, predictive factors associated with the occurrence of DCI differed significantly depending on the corticosteroid treatment status (dexamethasone group: Hunt and Hess grade (p = 0.002), endovascular treatment (p = 0.016); no-dexamethasone group: acute hydrocephalus (p = 0.018), peripheral leukocyte count 7 days post SAH (WBC at day 7) (p = 0.009)). Similar disparities were found for VP shunt dependency (dexamethasone group: acute hydrocephalus (p = 0.002); no-dexamethasone group: WBC d7 (p = 0.036), CRP peak within 72 h (p = 0.015)). Our study shows that corticosteroid-induced leukocytosis negates the predictive prognostic potential of systemic inflammatory markers for DCI and VP shunt dependency, which has previously been neglected and should be accounted for in future studies.<\/jats:p>","DOI":"10.3390\/jcm12031006","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T01:33:37Z","timestamp":1675042417000},"page":"1006","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Corticosteroid-Dependent Leukocytosis Masks the Predictive Potential of White Blood Cells for Delayed Cerebral Ischemia and Ventriculoperitoneal Shunt Dependency in Aneurysmatic Subarachnoid Hemorrhage"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5300-6594","authenticated-orcid":false,"given":"Andras","family":"Piffko","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"},{"name":"Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA"},{"name":"Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL 60637, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz L.","family":"Ricklefs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nils","family":"Schweingruber","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Sauvigny","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7467-9672","authenticated-orcid":false,"given":"Marius Marc-Daniel","family":"Mader","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"},{"name":"Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malte","family":"Mohme","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lasse","family":"D\u00fchrsen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfred","family":"Westphal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9511-2261","authenticated-orcid":false,"given":"Jan","family":"Regelsberger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Diako Hospital Flensburg, 24939 Flensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6910-8843","authenticated-orcid":false,"given":"Nils Ole","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Regensburg University Hospital, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0865-241X","authenticated-orcid":false,"given":"Patrick","family":"Czorlich","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/S0140-6736(07)60153-6","article-title":"Subarachnoid haemorrhage","volume":"369","author":"Kerr","year":"2007","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S1474-4422(09)70126-7","article-title":"Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: A meta-analysis","volume":"8","author":"Nieuwkamp","year":"2009","journal-title":"Lancet 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