Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage

Giede-Jeppe, Antje; Bobinger, Tobias; Gerner, Stefan T.; Sembill, Jochen A.; Sprügel, Maximilian I.; Beuscher, Vanessa D.; Lücking, Hannes; Hoelter, Philip; Kuramatsu, Joji B.; Huttner, Hagen B.

doi:10.1159/000468996

Cited by 97 publications

(108 citation statements)

References 41 publications

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“…These data indicate that the peripheral cellular immune system changed dramatically in the immediate aftermath of ICH. Conversely, the systemic cellular and molecular immune response might also influence local immune response in the hematoma and the outcome of patients with ICH . Although DCs, M/MΦ, neutrophils, lymphocytes (Treg cells, Th17 cells, TCRγδ T cells, etc.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence indicates that pro‐inflammatory cells (Th cells, M1 M/MΦ), cytokines (IL‐17, IL‐23), anti‐inflammatory cells (Treg cells, M2 M/MΦ), and cytokines (IL‐4, IL‐10, TGF‐β) participate in the inflammatory response . Studies also show that changes in the cellular and molecular immune system are associated with ICH outcomes . Although previous studies have suggested a relationship between neutrophil‐to‐lymphocyte ratio or white blood cell count and the prognosis of patients with ICH, no study has explored the relationship between ICH severity/outcomes and the systemic and local response of the cellular and molecular immune system.…”

Section: Discussionmentioning

confidence: 99%

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Immune changes in peripheral blood and hematoma of patients with intracerebral hemorrhage

Jiang

Wang

et al. 2020

FASEB j.

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Immunologic changes in the hematoma of patients with intracerebral hemorrhage (ICH) and the contribution of these changes to prognosis are unknown. We collected the blood samples and hematoma fluid from 35 patients with acute ICH (<30 hours from symptom onset) and 55 age-matched healthy controls. Using flow cytometry and ELISA, we found that the percentages of granulocytes, regulatory T cells, helper T (Th) 17 cells, and dendritic cells were higher in the peripheral blood of patients with ICH than in healthy controls, whereas the percentages of lymphocytes, M1-like macrophages, and M2-like macrophages were lower. Levels of IL-6, IL-17, IL-23, TNF-α, IL-4, IL-10, and TGF-β were higher in the peripheral blood of patients with ICH. The absolute counts of white blood cells, lymphocytes, monocytes, and granulocytes in the hematoma tended to be greater at 12-30 hours than they were within 12 hours after ICH, but the percentage of Th cells decreased in peripheral blood.Increased levels of IL-10 in the serum and hematoma, and a reduction in M1-like macrophages in hematoma were independently associated with favorable outcome on day 90. These results indicate that immunocytes present in the hematoma may participate in the acute-phase inflammatory response after ICH. K E Y W O R D Shematoma, immune changes, intracerebral hemorrhage, outcome, patients | 2775 JIANG et Al.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Immune changes in peripheral blood and hematoma of patients with intracerebral hemorrhage

Jiang

Wang

et al. 2020

FASEB j.

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“…Yet accounting for sepsis would rather benefit the cancer patient group and this therefore supports the conclusion of our study. A possible reason why an additional cancer diagnosis does not impact long-term prognosis after ICH relates to the severity of the bleeding itself, as demonstrated previously [3,24,32,33,34]. Therefore, the intuitive prognostication that ICH patients with cancer show worse outcomes needs a strong counterbalance to avoid early treatment restrictions and thus self-fulfilling prophecies [12,35].…”

Section: Discussionmentioning

confidence: 90%

Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage

Sprügel

Kuramatsu²,

Gerner³

et al. 2017

Cerebrovasc Dis

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Background: Data on clinical characteristics and outcome of patients with intracerebral hemorrhage (ICH) and concomitant systemic cancer disease are very limited. Methods: Nine hundred and seventy three consecutive primary ICH patients were analyzed using our prospective institutional registry over a period of 9 years (2006-2014). We compared clinical and radiological parameters as well as outcome - scored using the modified Rankin Scale (mRS) and analyzed in a dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable outcome (mRS = 4-6) - of ICH patients with and without cancer. Relevant imbalances in baseline clinical and radiological characteristics were adjusted using propensity score (PS) matching. Results: Prevalence of systemic cancer among patients with ICH was 8.5% (83/973). ICH patients with cancer were older (77 [70-82] vs. 72 [63-80] years; p = 0.002), had more often prior renal dysfunction (19/83 [22.9%] vs.107/890 [12.0%]; p = 0.005), and smaller hemorrhage volumes (10.1 [4.8-24.3] vs. 15.3 [5.4-42.9] mL; p = 0.017). After PS-matching there were no significant differences neither in mortality nor in functional outcome both at 3 months (mortality: 33/81 [40.7%] vs. 55/158 [34.8%]; p = 0.368; mRS = 0-3: 28/81 [34.6%] vs. 52/158 [32.9%]; p = 0.797) and 12 months (mortality: 39/78 [50.0%] vs. 70/150 [46.7%]; p = 0.633; mRS = 0-3: 25/78 [32.1%] vs. 53/150 [35.3%]; p = 0.620) among patients with and without concomitant systemic cancer. ICH volume tended to be highest in patients with hematooncologic malignancy and smallest in urothelial cancer. Conclusions: Patients with ICH and concomitant systemic cancer on average are older; however, they show smaller ICH volumes compared to patients without cancer. Yet, mortality and functional outcome is not different in ICH patients with and without cancer. Thus, the clinical history or the de novo diagnosis of concomitant malignancies in ICH patients should not lead to unjustified treatment restrictions.

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“…The NLR increases with time in the first few days. Many previous studies [26][27][28]34] suggested that NLR increases within 12 h after onset and reaches the peak levels the second day. Accurately determining the optimal time to test requires additional research.…”

Section: Figurementioning

confidence: 94%

The prediction of neutrophil to lymphocyte ratio for outcomes in ischemic stroke

Ye¹,

Ai²,

Fang³

et al. 2017

Oncotarget

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Objective: Neutrophil to lymphocyte ratio (NLR) is a prognostic inflammatory biomarker in patients with cardiovascular disease and hemorrhagic stroke. This metaanalysis aims to evaluate the prognostic values of NLR in predicting clinical outcomes in patients with ischemic stroke.Methods: A literature search was performed using the databases PubMed, EMBASE, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure. Two reviewers independently retrieved papers that met the inclusion criteria. Subgroup analyses were performed using in-hospital mortality, 90-day mortality and 90-day poor outcomes (mRS>2) as the outcome measures.Results: Eight studies with 3855 patients were included in the analysis. An elevated NLR was a strong predictor for in-hospital mortality (OR: 1.05; 95% CI: 1.03-1.07, p<0.001) and for 90-day poor outcomes (OR: 2.28; 95% CI: 1.39-3.73, p<0.001), but not for 90-day mortality (OR: 3.04; 95% CI: 0.74-12.55, p=0.12). After performing subgroup analysis, the NLR was found to predict 90-day mortality with a high (>5) cut-off values (OR: 6.69; 95% CI: 1.70-26.33, p=0.007). The lower cut-off values had no significance (OR: 2.17; 95% CI: 0.43-10.86, p=0.35).Conclusions: A high NLR was significantly associated with higher rates of inhospital mortality and 90-day poor outcome in patients with ischemic stroke, especially with a high mean NLR or high cut-off values. With a high cut-off value (>5), NLR could predict the 90-day mortality after ischemic stroke.

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Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage

Cited by 97 publications

References 41 publications

Immune changes in peripheral blood and hematoma of patients with intracerebral hemorrhage

Immune changes in peripheral blood and hematoma of patients with intracerebral hemorrhage

Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage

The prediction of neutrophil to lymphocyte ratio for outcomes in ischemic stroke

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