Inflammatory and oxidative stress markers in intracerebral hemorrhage: Relevance as prognostic markers for quantification of the edema volume

Abstract

We aimed to analyze the inflammatory and oxidative stress (OS) markers after intracerebral hemorrhage (ICH) and their temporal changes, interaction effects, and prognostic values as biomarkers for the prediction of the edema volume. Our prospective, longitudinal study included a cohort group of 73 conservatively treated patients with ICH, without hematoma expansion or intraventricular bleeding, which were initialized with the same treatment and provided with the same in-hospital care during the disease course. Study procedures included multilevel comprehensive analyses of clinical and neuroimaging data, aligned with the exploration of 19 inflammatory and five OS markers. White blood cells (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophilia, and lymphopenia peaked 3 days post-ICH, and they showed much stronger correlations with clinical and neuroimaging variables, when compared to the admission values. An intricate interplay among inflammatory (WBC, CRP, neutrophils, neutrophil-to-lymphocyte ratio [NLR], interleukin (IL)-6, and IL-10) and OS mechanisms (catalase activity and advanced oxidation protein products [AOPP]) was detected operating 3-days post-ICH, being assessed as relevant for prediction of the edema. The overall results suggested complex pathology of formation of post-ICH edema, via: (A) Not additive, but statistically significant synergistic interactions between CRP-ESR, neutrophils-CRP, and neutrophils-IL-6 as drivers for the edema formation; (B) Significant antagonistic effect of high protein oxidation on the CRP-edema dependence, suggesting a mechanism of potential OS-CRP negative feedback loop and redox inactivation of CRP. The final multiple regression model separated the third-day variables NLR, CRP Â AOPP, and WBC, as significant prognostic biomarkers for the prediction of the edema volume, with NLR being associated with the highest effect size. Our developed mathematical equation with 3D modeling for prediction and quantification of the edema volume might be beneficial for taking timely adequate strategies for prevention of delayed neurological deteriorations.

Neutrophil-to-lymphocyte ratio on admission predicts early perihematomal edema growth after intracerebral hemorrhage

“…Vladimir et al showed a close correlation between NLR and neuroimaging markers (hematoma volume, especially edema volume) in their study. [9] Similar results were obtained in our research. After further analysis, we found that admission NLR could be a predictor of early PHE growth.…”

Neutrophil‐to‐Lymphocyte ratio on admission predicts gastrointestinal bleeding in acute basal ganglia hemorrhage

“…NLR was usually considered as a sensitive marker for severity of diseases, such as cancer, infection, and stroke 15,37,38 . In ICH patients, NLR and ANC were synergistically on propagation of the inflammatory cascade which enhanced the IL‐6 effects on the edema volume 39 . In experimental BGH, neutrophil infiltration with the high level of IL‐6 and IL‐1β was obvious in the intestine and blood circulation in acute stage 6,40 .…”

“…15,37,38 In ICH patients, NLR and ANC were synergistically on propagation of the inflammatory cascade which enhanced the IL-6 effects on the edema volume. 39 In experimental BGH, neutrophil infiltration with the high level of IL-6 and IL-1β was obvious in the intestine and blood circulation in acute stage. 6,40 It suggested that these activated cytotoxic factors played the important role in gut mucosal damage and barrier dysfunction.…”

Prognostic value of neutrophils to lymphocytes and platelets ratio for 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study

“…An elevated NLR value usually means an increase in neutrophils (reflecting a proinflammatory state) and/ or a decrease in lymphocytes (reflecting the weak adaptive immunity to diseases). Therefore, NLR has been suggested to predict the severity and mortality of various diseases, such as sepsis [7], community-acquired pneumonia [8,9], chronic obstructive pulmonary disease [10,11], acute limb ischemia [12], acute cholecystitis [13], cardiovascular disease [14][15][16], and intracerebral hemorrhage [17,18], as well as the recent pandemic COVID-19 pneumonia [14,[19][20][21].…”