Association Between Eosinophilic Leukocyte Count and Hematoma Expansion in Acute Spontaneous Intracerebral Hemorrhage

Abstract

Background/Objective: Hematoma expansion (HE) predicts poor outcome and is an appealing treatment target in spontaneous intracerebral hemorrhage (ICH). Clinical evidence has shown an association of HE with peripheral white blood cells (WBC) count, but the individual contributions of leukocyte subtypes between literatures are described inconsistently. Our aim was to determine the relationship between admission absolute and differential leukocyte counts and HE by using different growth definitions.Methods: We analyzed spontaneous ICH patients who underwent baseline cranial computed tomography and blood sampling within 6 h of stroke onset in our institution between September 2013 and August 2018. Hematoma volume was calculated using a semiautomated 3-dimensional reconstruction algorithm. According to commonly used absolute or relative growth definitions (>6 mL, >12.5 mL, or >33%), we defined 5 types of HE. A propensity score-matching analysis was performed to evaluate the influence of complete blood count components on HE across the various growth definitions. The receiver operating characteristic analysis assessed the predictive ability of leukocyte counts for HE.Results: A total of 1,066 patients were included, of whom 11–21% met the 5 HE definitions. After propensity score-matching, except using the definition of >12.5 mL growth or its combination with >33% growth, both WBC and neutrophil count were independently associated with reduced risk of HE (odds ratio [OR] for 103 cells increase; OR, 0.86–0.99; all p < 0.05) after adjusting confounders in multivariate analyses. However, monocyte count was correlated with increased risk of HE under the usage of >12.5 mL expansion definition only (OR, 1.43; p = 0.024). There was no association between lymphocyte count and HE (all p > 0.05). Regardless of the growth definition, admission eosinophil count was directly associated with the risk of HE (OR, 6.92–31.60; all p < 0.05), and was the best predictive subtype with area under the curve 0.64, sensitivity 69.5%, and specificity 58.9% at the optimal cut-off value of 45 cells/μL.Conclusions: Growth definition affects the relationship of HE with leukocyte subtypes counting. Eosinophil count robustly predicts HE, and may be a surrogate when using an inflammatory marker to help select acute ICH patients with high expansion risk for hemostasis treatment in clinical trial and practice.

Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

“…Present results offer granulocytes as a surrogate for NEU and the question of POC granulocytes timerelated augmentation arises, if considering the one reported on NEU [53]. Monocytes are substituted by MID, which include eosinophils among others, whose contribution to sICH evolution is still uncharted [55]. Therefore, larger cohorts are required for validating the impact of POC testing in acute sICH.…”

Various effects of nutritional status on clinical outcomes after intracerebral hemorrhage

“…The reason why lymphopenia is associated with initial ICH volumes, but not with HE, is unclear. Although it might be influenced by various definitions of HE, another report showed that there was no association between lymphocyte count and HE across various definitions [29]. Regarding HE, total cholesterol levels were lower in patients with HE than in those without HE in a prospective study [19].…”

Emergency department point‑of‑care biomarkers and day 90 functional outcome in spontaneous intracerebral hemorrhage: A single‑center pilot study

“…Recent evidence has shown a significant increase in peripheral WBC, GRA and MON population in patients with acute ICH, whereas the LYM population has decreased ( 48 ). The contribution of EOS to sICH prognostication is not completely understood; however, Chen et al ( 14 ) correlated EOS count with increased risk of HE. Moreover, the short interval from symptom onset to CBC sampling in the present cohort ( 39 ) might have prevented the documentation of the activation of local and systemic inflammation ( 13 , 22 , 48 ).…”

“…hemorrhage: A single-center pilot study associated with mortality (5,(7)(8)(9)(10)(11). Moreover, early neurological worsening (ENW) (12), hematoma volume expansion and the expansion of the surrounding edema (5,13,14), and day 90 functional outcome (FO) (6,13,(15)(16)(17)(18)(19) have also been reported to be associated with mortality. Furthermore, systemic immune-inflammation index (SII) has been recently reported as a relevant predictor of poor hospital discharge outcome (20).…”

“…CBC upon admission, which includes hemoglobin (Hb), red blood cells and their distribution width (RDW), and derived inflammatory indexes, such as neutrophils-to-lymphocytes ratio (NLR), lymphocytes-to-monocytes ratio (LMR), platelets-to-lymphocytes ratio (PLR) and C-reactive protein (CRP), have been associated with mortality ( 5 , 7-11 ). Moreover, early neurological worsening (ENW) ( 12 ), hematoma volume expansion and the expansion of the surrounding edema ( 5 , 13 , 14 ), and day 90 functional outcome (FO) ( 6 , 13 , 15-19 ) have also been reported to be associated with mortality. Furthermore, systemic immune-inflammation index (SII) has been recently reported as a relevant predictor of poor hospital discharge outcome ( 20 ).…”