Early elevated neutrophil‐to‐lymphocyte ratio associated with remote diffusion‐weighted imaging lesions in acute intracerebral hemorrhage

Abstract

Aims To explore the relationship between the circulating neutrophil‐to‐lymphocyte ratio (NLR) and the remote diffusion‐weighted imaging lesions (R‐DWILs) after spontaneous intracerebral hemorrhage (ICH). Methods Consecutive patients with spontaneous ICH were prospectively collected from November 2016 to May 2018 and retrospectively analyzed. We included subjects who presented within 24 hours after symptom onset and were free of detectable infections on admission or in hospital. Blood samples were obtained at 24‐48 hours after ICH ictus, while all complete MRI scans were performed at 5‐8 days. R‐DWILs were defined as focal hyperintensities remote from the site of the ICH or the peri‐hematoma regions. NLR was calculated by dividing the absolute neutrophil counts by the absolute lymphocyte counts. Multivariate binary logistic regression models were generated to evaluate the relationship between NLR and R‐DWILs. Results One hundred sixty‐three subjects met eligibility criteria (age 62.3 ± 13.6 years, 60.7% males), of whom 31(19.0%) experienced R‐DWILs. Higher circulating NLR was documented in patients with R‐DWILs. With the best cutoff value of 6.01, elevated NLR was independently associated with the presence of R‐DWILs (OR = 3.170, 95% CI 1.306‐7.697, P = .011) in the bivariate logistic regression analysis with adjustment for age, sex, atrial fibrillation, previous ischemic stroke/TIA, SBP on admission, hematoma volume, and IVH. Conclusions This study provides significant evidence of the association between circulating NLR and R‐DWILs in spontaneous ICH patients. Patients with NLR > 6.01 at 24‐48 hours after ICH ictus should be paid more attention to when evaluating R‐DWILs.

Application of neutrophil to lymphocyte ratio to identify CT-negative cerebral infarction with nonfocal symptoms

“…Our results showed that the cerebral infarction group had higher NLR than the non-cerebral infarction group. A previous study revealed that early elevated NLR was associated with remote DWI(+) lesions in acute intracerebral hemorrhage (32). It is well established that inflammation is acutely involved in the process of ischemic stroke (33).…”

Iron chelation suppresses secondary bleeding after intracerebral hemorrhage in angiotensin II‐infused mice

“…Iron overload during the process of Ang II‐induced hypertension might exacerbates brain injury after ICH by inflammatory activation. Both ICH‐related systemic inflammation 44 , 45 and microglia/macrophage‐mediated inflammation activation 46 play an important role in brain injury, recovery, and stroke outcome. In our study, increased vascular inflammation (indicated by MCP‐1‐and Mac2‐positive cells and IBA‐1 positive cells) were observed in Ang II‐infused mice, while, iron chelation decreased inflammatory activation and secondary bleeding.…”

“…Iron overload during the process of Ang II-induced hypertension might exacerbates brain injury after ICH by inflammatory activation. Both ICH-related systemic inflammation 44,45 and microglia/macrophage-mediated inflammation activation 46 play an important role in brain injury, recovery, and stroke outcome. In In addition, after ICH modeling, we observed obvious accumulation of astrocytes, the inhibition of which has been reported to decrease HE and BBB destruction in collagenase-induced ICH rats.…”

Machine learning models predict coagulopathy in spontaneous intracerebral hemorrhage patients in ER

“…Previous prospective studies have shown that elevated admission WBC count and neutrophil count are associated with an increased risk of early neurologic deterioration in ICH [37][38][39] as well as in ischemic stroke. 40 Multiple studies have also reported increased neutrophil-to-lymphocyte ratio associated with higher mortality and increased intracerebral remote diffusion-weighted imaging lesions in ICH, 41,42 and worsened prognosis in glioma. 43 Although the Multiple prospective investigations have indicated that achieving early and stable blood pressure seems safe and associated with favorable outcomes in acute ICH patients.…”