Objective  To understand the dynamic changes of inflammatory indicators in the peripheral blood of patients with malignant cerebral edema at different time points after acute cerebral infarction, and provide a basis for early prediction and prevention of malignant cerebral edema. Methods  Consecutive patients with acute cerebral infarction within 24 h of onset who were admitted to the Department of Neurology, West China Hospital of Sichuan University between January 1st, 2017 to December 31st, 2018 were collected. The basic clinical data of the patients were collected, and the data of inflammatory cells (white blood cell count, absolute neutrophil count, absolute lymphocyte count, and neutrophil to lymphocyte ratio) and acute phase reactants (blood glucose, fibrinogen, albumin, and fibrinogen to albumin ratio) were dynamically collected at admission and 1, 3, and 7 d after admission, respectively. Differences between groups were compared using generalized estimating equations. Results  A total of 798 patients with acute cerebral infarction were included, of whom 93 (11.65%) developed malignant cerebral edema. At all time points examined, the white blood cell counts, absolute neutrophil counts, and neutrophil to lymphocyte ratios were higher in the malignant cerebral edema group than those in the non-malignant cerebral edema group (Wald χ²=63.737, P<0.001; Wald χ²=91.848, P<0.001; Wald χ²=75.197, P<0.001); 1 and 3 d after admission, the absolute lymphocyte counts were lower in the malignant cerebral edema group than those in the non-malignant cerebral edema group (Wald χ²=18.580, P<0.001). The blood glucose levels were higher in the malignant cerebral edema group compared with the non-malignant cerebral edema group 1, 3, and 7 d after admission (Wald χ²=16.722, P<0.001); no significant between-group effect was found in the albumin levels (Wald χ²=3.643, P=0.056); the fibrinogen levels were significantly different between groups 3 d after admission (Wald χ²=8.923, P=0.003), and the fibrinogen to albumin ratios differed between the two groups 3 and 7 d after admission (Wald χ²=6.739, P=0.009). Dynamic analysis of multiple time points in the malignant cerebral edema group found that these inflammatory markers mostly reached their extreme values 3 d after admission. Conclusions  Compared with the non-malignant cerebral edema group, the inflammatory cell-related indicators (except lymphocytes) and the acute phase inflammatory reactant-related indicators in malignant cerebral edema patients are significantly higher, and the absolute lymphocyte count is significantly lower. Three days after admission to hospital is probably the most significant time point for the change of each inflammatory indicator.

Citation： GUO Wen, WANG Lu, LIU Ming. Dynamic changes of inflammatory indicators in patients with malignant cerebral edema after acute cerebral infarction. West China Medical Journal, 2022, 37(6): 816-822. doi: 10.7507/1002-0179.202204076 Copy