Response by Lattanzi and Silvestrini to Letter Regarding Article, “Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage”

Lattanzi, Simona; Silvestrini, Mauro

doi:10.1161/strokeaha.116.014263

Cited by 4 publications

(3 citation statements)

References 3 publications

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“…Immune reaction is a major feature of ICH pathology and influences its course; the response to cerebral hematoma is not bounded to the brain and results in systemic effects, and inflammatory markers on admission, such as fever, elevated leukocyte count, interleukin-6 and C-reactive protein are associated with worse prognosis [ 3 – 5 ]. The neutrophil-to-lymphocyte ratio (NLR), an easily available synthesis of the inflammatory levels and enhanced immune pathways, is associated to 3-month recovery in ICH patients [ 6 , 7 ], but its link with short term outcome is unknown. The aim of this study was to evaluate the relationship between the total and differential leukocyte counts and the NLR at admission with the occurrence of ND during the initial week after ICH onset.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage

et al. 2017

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Immunity plays key roles in pathophysiology of intracerebral hemorrhage (ICH). The aim of the study was to determine whether the peripheral leukocyte count and neutrophil-to-lymphocyte ratio (NLR) predicted neurological deterioration (ND) after ICH. We identified consecutive patients with ICH who had blood sampling performed within 24 hours from symptom's onset. Total white blood cells (WBC), absolute neutrophil count (ANC) and absolute lymphocyte count (ALC) were retrieved, and the NLR computed as the ratio of the ANC to ALC values. The study endpoint was the occurrence of neurological deterioration (ND) within 7 days after ICH. One hundred ninety-two subjects were enrolled, whose 54 (28.1%) presented ND. At multivariate analysis, the WBC (adjusted odd ratio [adjOR] for 1,000 leukocytes increase 1.29, 95% confidence interval [CI] 1.11-1.50), ANC (adjOR for 1,000 neutrophils increase 1.61, 95% CI 1.30-1.99), ALC (adjOR for 1,000 lymphocytes increase 0.21, 95% CI 0.09-0.49) and NLR (adjOR for 1-point increase 1.65, 95% CI 1.36-2.00) were independently associated with ND (p≤0.001). The NLR resulted the best discriminating variable for the occurrence of the adverse outcome (area under the curve 0.888, 95% CI 0.832-0.945; p < 0.001). The NLR predicted ND after acute ICH and can aid in the risk stratification of patients.

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Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage

et al. 2017

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“…Additionally, we also revealed that pre-treated the rats with AT 1 R inhibitors can significantly reduce the infarct volume along with the decline of neurological deficits. These results need to be further verified whether pre-treat the AIS patients with AT 1 R antagonist could decrease the infarct volume and NIHSS score as compared with other kinds of anti-hypertension drugs in our future work [ 22 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Up-regulation of angiotensin-converting enzyme in response to acute ischemic stroke via ERK/NF-κB pathway in spontaneously hypertensive rats

Tao

Gao

et al. 2017

Oncotarget

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Cerebral ischemic stroke is usually caused by a temporary or permanent decrease in blood supply to the brain. Despite general progress in diagnosis and treatment, the prognosis of stroke is still unsatisfactory, and more detailed potential mechanisms are needed to investigate underlying the pathological process. Here, we showed that serum angiotensin-converting enzyme (ACE) concentration was positively correlated with infarct volume after acute ischemic stroke (AIS). Moreover, using a permanent middle cerebral artery occlusion rat model, we indicated for the first time that increased ACE expression in response to AIS was regulated by the ERK/NF-κB pathway in peri-infarct regions. More importantly, we disclosed that angiotensin II type 1 receptors were implicated in up-regulation of ACE expression in peri-infarct regions. These findings offer insight into ACE expression and activity in response to stroke, and further our understanding of ACE mechanisms.

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“…The NLR is associated with short-term and 3-month outcome in patients with ICH, but its relationship with early hematoma growth is unknown. 7–14 Therefore, this study aimed to determine the association between the NLR at admission and early hematoma growth after spontaneous ICH.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio predicts hematoma growth in intracerebral hemorrhage

et al. 2019

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Objective Early hematoma growth is a major determinant of early neurological deterioration and poor clinical outcome in patients with spontaneous intracerebral hemorrhage (ICH). Inflammation plays a major role in the pathophysiology of ICH. This study aimed to evaluate the potential of the neutrophil-to-lymphocyte ratio (NLR) for predicting early hematoma growth after ICH. Methods A retrospective review was performed of patients with acute spontaneous ICH who were admitted to the Stroke Center of the First People’s Hospital of Jingmen between January 2014 and January 2017. The NLR was computed from admission blood work. Brain computed tomography scans were performed at admission and repeated within 24 hours. Hematoma growth was defined as absolute growth >6 mL or relative growth >33%. Results A total of 123 patients were included and early hematoma growth occurred in 30 (24%) patients. Multivariate analysis showed that the NLR (odds ratio, 1.22; 95% confidence interval, 1.09–1.38) was independently associated with early hematoma growth. The best predictive cut-off of the NLR for early hematoma growth was 6.49 (sensitivity, 50%; specificity, 69%). Conclusions A high NLR is independently predictive of early hematoma growth and may aid in risk stratification of patients with ICH on admission.

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Response by Lattanzi and Silvestrini to Letter Regarding Article, “Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage”

Cited by 4 publications

References 3 publications

Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage

Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage

Up-regulation of angiotensin-converting enzyme in response to acute ischemic stroke via ERK/NF-κB pathway in spontaneously hypertensive rats

Neutrophil-to-lymphocyte ratio predicts hematoma growth in intracerebral hemorrhage

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