Monocyte Count and 30-Day Case Fatality in Intracerebral Hemorrhage

Walsh, Kyle B; Sekar, Padmini; Langefeld, Carl D.; Moomaw, Charles J.; Elkind, Mitchell S.V.; Boehme, Amelia K; James, Michael L.; Osborne, Jennifer; Sheth, Kevin N; Woo, Daniel; Adeoye, Opeolu

doi:10.1161/strokeaha.115.009880

Cited by 74 publications

(64 citation statements)

References 15 publications

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“…Inflammation plays an important role in cerebrovascular diseases [1][2][3][4] , including intracerebral hemorrhage (ICH) [5][6][7] and is usually monitored using a variety of biochemical and hematological markers [8][9][10][11][12] . Neutrophil-to-lymphocyte ratio (NLR), calculated by the absolute neutrophil count divided by the absolute lymphocyte count, is increasingly recognized as a readily available and inexpensive biomarker for systemic inflammation [13] .…”

Section: Neutrophil-to-lymphocyte Ratio Is Anmentioning

confidence: 99%

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

Giede-Jeppe¹,

Bobinger²,

Gerner³

et al. 2017

Cerebrovasc Dis

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Health Stroke Scale [NIHSS] 18 [9-32] vs. 10 [4-21]; p < 0.001), larger hematoma volume on admission (17.6 [6.9-47.7] vs. 10.6 [3.8-31.7] mL; p = 0.001), and more frequently unfavorable outcome 116/641; p < 0.001), and increased c-reactive-protein levels on admission ( p < 0.001; R 2 = 0.064). Adjusting for the abovementioned baseline confounders, multivariable logistic analyses revealed independent associations of NLROA with inhospital mortality (OR 0.967, 95% CI 0.939-0.997; p = 0.029). Conclusions: NLR represents an independent parameter associated with increased mortality in ICH patients. Stroke physicians should focus intensely on patients with increased NLR, KeywordsIntracerebral hemorrhage · Neutrophil-to-lymphocyte ratio · Inflammation · In-hospital mortality Abstract Background and Purpose: Stroke-associated immunosuppression and inflammation are increasingly recognized as factors that trigger infections and thus, potentially influence the outcome after stroke. Several studies demonstrated that elevated neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of adverse outcomes in patients with ischemic stroke. However, little is known about the impact of NLR on short-term mortality in intracerebral hemorrhage (ICH). Methods: This observational study included 855 consecutive ICH-patients. Patient demographics, clinical, laboratory, and in-hospital measures as well as neuroradiological data were retrieved from institutional databases. Functional 3-monthsoutcome was assessed and categorized as favorable (modified Rankin Scale [mRS] 0-3) and unfavorable (mRS 4-6). We (i) studied the natural course of NLR in ICH, (ii) analyzed parameters associated with NLR on admission (NLROA), and (iii) evaluated the clinical impact of NLR on mortality and functional outcome. Results: The median NLROA of the entire cohort was 4.66 and it remained stable during the entire hospital stay. Patients with NLR ≥ 4.66 showed significant associations with poorer neurological status (National Institute of

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Section: Neutrophil-to-lymphocyte Ratio Is Anmentioning

confidence: 99%

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

Giede-Jeppe¹,

Bobinger²,

Gerner³

et al. 2017

Cerebrovasc Dis

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“…Clinical studies by our group and others have contributed to an increasing body of evidence that monocytes play an important role in the secondary inflammatory injury after ICH. 10,11,13 Preclinical studies have also supported a specific role for monocytes, as they were the major cell recruited to ICH site in a murine model, and mice with attenuation of monocyte number or activity had better functional outcomes after ICH. 8,9 mMP are released in vivo as a result of cellular activation or apoptosis, and they can have proinflammatory effects primarily through activation of endothelial cells, fibroblasts, smooth muscle cells, and autocrine effects on other monocytes.…”

Section: Discussionmentioning

confidence: 95%

“…8–12 We previously found in 2 independent cohorts of ICH patients that higher monocyte count was associated with 30-day case-fatality. 10,11 Higher levels of chemokine C-C motif ligand 2 (CCL2), the dominant cytokine for monocyte recruitment, were independently associated with poor functional outcome after ICH. 9 In a recent investigation of 1302 ICH patients, higher admission monocyte count was an independent predictor of ICH hematoma expansion.…”

Section: Introductionmentioning

confidence: 99%

M2 Monocyte Microparticles Are Increased in Intracerebral Hemorrhage

Walsh

Campos²,

Hart

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background Intracerebral hemorrhage (ICH) is a severe neurologic condition with no proven treatment. Recent evidence suggests that monocytes, a heterogenous group of cells with M1 and M2 phenotypes, contribute to secondary damage following ICH. Microparticles are vesicles .1–1 μm in size that are released from cells. We hypothesized that M1 and M2 monocyte microparticles (mMP) would be differentially expressed in ICH cases and controls. Methods In a single-center, prospective, observational study, consecutive ICH cases were enrolled within 12 hours of symptom onset. Age (±5 years)-, race-, and sex-matched controls were recruited. M1 and M2 mMP numbers were determined in plasma samples using flow cytometry and protein biomarkers using standardized assays. The Mann–Whitney U test compared M1 and M2 mMP counts between cases and controls. Standardized regression coefficients compared M1 and M2 mMP with C-reactive protein (CRP) and serum amyloid A (SAA). Results Nineteen ICH case-control pairs were enrolled. The median number of M1 mMP was not significantly different between ICH cases (8.63 × 107/milliliter (mL)) compared with controls (8.64 × 107/mL), (P = .525). The median number of M2 mMP was significantly higher in ICH cases (1.61 × 106/mL) compared with controls (4.46 × 105/mL) (P = .027). There were no significant associations for M1 or M2 mMP with CRP or SAA. Conclusion Higher numbers of M2 mMP in ICH cases compared with controls is hypothesis generating. It may represent differences in the chronic inflammatory status in patients susceptible to ICH, such as cellular activation or apoptosis. Further research is needed, including serial plasma samples, to elucidate the pathophysiology of monocytes and mMP following ICH.

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“…1 Our response addresses two points raised in their letter: 1) evidence that infiltrating neutrophils (not monocytes) play a role in intracerebral hemorrhage (ICH)-induced brain injury; and, 2) their multivariate logistic regression analysis of 321 ICH patients which found (contrary to our analysis) that higher total white blood cell (WBC) and neutrophil count, but not monocyte count, were independently associated with mortality.…”

mentioning

confidence: 80%