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Systemic inflammation status at admission affects the outcome of intracerebral hemorrhage by increasing perihematomal edema but not the hematoma growth

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Abstract

Acute stress and inflammation responses are associated with worse outcomes in intracerebral hemorrhage (ICH) but the precise mechanisms involved are unclear. We evaluated the effect of neutrophil-to-lymphocyte ratio (NLR) in ICH outcome, with focus on hematoma expansion and early cerebral edema. In a retrospective study, we included all patients with primary ICH admitted to our center within 24-h from symptom onset from January 2014 to February 2015. We retrieved demographic and medical history data, Glasgow Coma Scale scores, blood cell counts, glucose, and C-reactive protein, and calculated NLR. We obtained hematoma volumes by computerized planimetry. Outcomes included independence at 90 days (modified Rankin scale 0–2), mortality at 30 days, significant hematoma expansion (> 33% or > 6 mL) and early cerebral edema causing significant midline shift (> 2.5 mm) at 24 h. We included 135 patients. NLR independently associated with independence at 90 days (adjusted odds ratio (aOR) 0.79, 95% CI 0.67–0.93, p = 0.006) significant cerebral edema (aOR 1.08, 95%CI 1.01–1.15, p = 0.016) but not hematoma expansion (aOR 0.99, 95%CI 0.94–1.04, p = 0.736). The severity of midline shift was positively correlated with NLR (adjusted beta = 0.08, 95% CI 0.05–0.11, p < 0.001). In ICH, an immediate and intense systemic inflammatory response reduces the likelihood of a better functional outcome at 90 days, which is more likely to be explained by perihematomal edema growth than due to a significant hematoma expansion. These findings could have implications in new treatment strategies and trial designs, which endpoints tend to target exclusively hematoma enlargement.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    Sérgio Fonseca, Mafalda Seabra, Rafael Dias, Elsa Azevedo & Pedro Castro

  2. Department of Neuroradiology, Centro Hospitalar Universitário São João, Porto, Portugal

    Francisca Costa

  3. Department of Neurology, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    Mafalda Seabra, Rafael Dias, Elsa Azevedo & Pedro Castro

  4. Department of Neurology, Hospital Central do Funchal, Porto, Portugal

    Rafael Dias

  5. Department of Internal Medicine, Hospital Beatriz Angelo, Porto, Portugal

    Adriana Soares

  6. Neurocritical Care Unit, Department of Intensive Care, Faculty of Medicine, Centro Hospitalar Universitário São João, University of Porto, Porto, Portugal

    Celeste Dias

  7. Department of Neurology and Stroke Unit, Centro Hospitalar Universitário São João, Porto, Portugal

    Pedro Castro

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  1. Sérgio Fonseca
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Correspondence to Pedro Castro.

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Sérgio Fonseca, Francisca Costa, Mafalda Seabra, Rafael Dias, Adriana Soares, Celeste Dias, Elsa Azevedo, and Pedro Castro declare that they have no conflict of interest to disclose.

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Fonseca, S., Costa, F., Seabra, M. et al. Systemic inflammation status at admission affects the outcome of intracerebral hemorrhage by increasing perihematomal edema but not the hematoma growth. Acta Neurol Belg 121, 649–659 (2021). https://doi.org/10.1007/s13760-019-01269-2

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