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Higher Monocyte Count is Associated with 30-Day Case Fatality in Intracerebral Hemorrhage

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Abstract

Background

Previous studies have suggested that elevated neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) may be associated with poor outcomes in intracerebral hemorrhage (ICH). We sought to determine whether white blood cell (WBC) types were independently associated with poor outcome in ICH in a large cohort.

Methods

We performed a retrospective study of primary ICH at two academic centers. Cases were identified via ICD-9 code and verified via physician review. We included only those patients with WBC types obtained within 24 h of ICH onset.

Results

We identified 593 patients with primary ICH and WBC differentials in the first 24 h. Independent factors (OR, 95% CI) associated with 30-day case fatality were age > 80 (2.4 (1.4, 4.2)), p = 0.0023; NIHSS greater than median (3.9 (2.4, 6.3)), p < 0.0001; ICH volume quartiles (Q1: ref, Q2: 1.5 (0.7, 3.0), Q3: 3.2 (1.6, 6.6), Q4: 11.9 (5.3, 26.4)), p < 0.0001; non-lobar location (3.3 (1.9, 5.9)), p ≤ 0.0001; IVH (2.3 (1.4, 3.6)), p = 0.0005, monocytes greater than median (1.6 (1.0, 2.4)), p = 0.0457, and anticoagulant use (3.2 (1.8, 5.6)), p < 0.0001. Elevated NLR was not associated with higher case fatality.

Conclusions

We found that elevated monocytes were independently associated with 30-day case fatality. Future studies will investigate whether there are subgroups of ICH patients, including those with particular blood or imaging biomarkers, in which WBC types might help predict poor outcome and provide targets for intervention.

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References

  1. Wang J, Doré S. Inflammation after intracerebral hemorrhage. J Cereb Blood Flow Metab. 2007;27:894–908.

    Article  CAS  Google Scholar 

  2. Adeoye O, Walsh K, Woo JG, et al. Peripheral monocyte count is associated with case fatality after intracerebral hemorrhage. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2014;23:e107–11.

    Article  Google Scholar 

  3. Walsh KB, Sekar P, Langefeld CD, et al. Monocyte count and 30-day case fatality in intracerebral hemorrhage. Stroke. 2015;46:2302–4.

    Article  Google Scholar 

  4. Morotti A, Phuah CL, Anderson CD, et al. Leukocyte count and intracerebral hemorrhage expansion. Stroke. 2016;47:1473–8.

    Article  Google Scholar 

  5. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio predicts the outcome of acute intracerebral hemorrhage. Stroke. 2016;47:1654–7.

    Article  Google Scholar 

  6. Giede-Jeppe A, Bobinger T, Gerner ST, et al. Neutrophil-to-lymphocyte ratio is an independent predictor for in-hospital mortality in spontaneous intracerebral hemorrhage. Cerebrovasc Dis. 2017;44:26–34.

    Article  Google Scholar 

  7. Qin J, Li Z, Gong G, et al. Early increased neutrophil-to-lymphocyte ratio is associated with poor 3-month outcomes in spontaneous intracerebral hemorrhage. PLoS ONE. 2019;14:e0211833.

    Article  CAS  Google Scholar 

  8. Gusdon AM, Gialdini G, Kone G, et al. Neutrophil-lymphocyte ratio and perihematomal edema growth in intracerebral hemorrhage. Stroke. 2017;48:2589–92.

    Article  Google Scholar 

  9. McDonald CJ, Overhage JM, Barnes M, et al. The Indiana network for patient care: a working local health information infrastructure. Health Aff. 2005;24:1214–20.

    Article  Google Scholar 

  10. Williams LS, Yilmaz EY, Lopez-Yunez AM. Retrospective assessment of initial stroke severity with the NIH stroke scale. Stroke. 2000;31:858–62.

    Article  CAS  Google Scholar 

  11. Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27:1304–5.

    Article  CAS  Google Scholar 

  12. Hallevi H, Dar NS, Barreto AD, et al. The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med. 2009;37:969–74.

    Article  Google Scholar 

  13. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.

    Article  Google Scholar 

  14. Schisterman EF, Perkins NJ, Liu A, Bondell H. Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology. 2005;16:73–81.

    Article  Google Scholar 

  15. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5.

    Article  CAS  Google Scholar 

  16. Suzuki S, Kelley RE, Dandapani BK, Reyes-Iglesias Y, Dietrich WD, Duncan RC. Acute leukocyte and temperature response in hypertensive intracerebral hemorrhage. Stroke. 1995;26:1020–3.

    Article  CAS  Google Scholar 

  17. Castellanos M, Leira R, Tejada J, et al. Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages. J Neurol Neurosurg Psychiatry. 2005;76:691–5.

    Article  CAS  Google Scholar 

  18. Leira R, Dávalos A, Silva Y, et al. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology. 2004;63:461–7.

    Article  CAS  Google Scholar 

  19. Sun W, Peacock A, Becker J, Phillips-Bute B, Laskowitz DT, James ML. Correlation of leukocytosis with early neurological deterioration following supratentorial intracerebral hemorrhage. J Clin Neurosci. 2012;19:1096–100.

    Article  Google Scholar 

  20. Yu S, Arima H, Heeley E, et al. White blood cell count and clinical outcomes after intracerebral hemorrhage: the INTERACT2 trial. J Neurol Sci. 2016;361:112–6.

    Article  Google Scholar 

  21. Zhu B, Pan Y, Jing J, et al. Neutrophil counts, neutrophil ratio, and new stroke in minor ischemic stroke or TIA. Neurology. 2018;90:e1870–8.

    Article  Google Scholar 

  22. Gökhan S, Ozhasenekler A, Mansur Durgun H, Akil E, Ustündag M, Orak M. Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack. Eur Rev Med Pharmacol Sci. 2013;17:653–7.

    PubMed  Google Scholar 

  23. Nam KW, Kim TJ, Lee JS, et al. High neutrophil-to-lymphocyte ratio predicts stroke-associated pneumonia. Stroke. 2018;49:1886–92.

    Article  Google Scholar 

  24. Spahn JH, Kreisel D. Monocytes in sterile inflammation: recruitment and functional consequences. Arch Immunol Ther Exp (Warsz). 2014;62:187–94.

    Article  CAS  Google Scholar 

  25. Hammond MD, Taylor RA, Mullen MT, et al. CCR2 + Ly6C(hi) inflammatory monocyte recruitment exacerbates acute disability following intracerebral hemorrhage. J Neurosci. 2014;34:3901–9.

    Article  Google Scholar 

  26. Sansing LH, Harris TH, Kasner SE, Hunter CA, Kariko K. Neutrophil depletion diminishes monocyte infiltration and improves functional outcome after experimental intracerebral hemorrhage. Acta Neurochir Suppl. 2011;111:173–8.

    Article  Google Scholar 

  27. Delcourt C, Sato S, Zhang S, et al. Intracerebral hemorrhage location and outcome among INTERACT2 participants. Neurology. 2017;88:1408–14.

    Article  Google Scholar 

  28. Tilling EJ, El Tawil S, Muir KW. Do clinicians overestimate the severity of intracerebral hemorrhage? Stroke. 2019;50:344–8.

    Article  Google Scholar 

  29. Xu X, Chen X, Zhang J, et al. Comparison of the Tada formula with software slicer: precise and low-cost method for volume assessment of intracerebral hematoma. Stroke. 2014;45:3433–5.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Peter Castelluccio for his assistance.

Funding

This work was supported by awards from the IU Health Values Fund (IUH VFR365), the IU CTSI PDT (ICTSI NIH/NCRR RR025761), the IUH/IUSM Strategic Research Initiative, and an IU CTSI KL2 award (NIH, UL1TR001108, Shekhar PI).

Author information

Authors and Affiliations

  1. Department of Neurology, Indiana University School of Medicine, 355 West 16th St, Suite 3200, Indianapolis, IN, 46202, USA

    Jason Mackey, Ashley D. Blatsioris & Linda S. Williams

  2. Regenstrief Institute, Indianapolis, IN, USA

    Jason Mackey, Ravan J. L. Carter & Linda S. Williams

  3. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

    Chandan Saha & Elizabeth A. S. Moser

  4. Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol & Thomas J. Leipzig

  5. Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA

    Linda S. Williams

Authors
  1. Jason Mackey
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  2. Ashley D. Blatsioris
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  3. Chandan Saha
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  4. Elizabeth A. S. Moser
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  5. Ravan J. L. Carter
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  6. Aaron A. Cohen-Gadol
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  7. Thomas J. Leipzig
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  8. Linda S. Williams
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Contributions

JM done the study concept and design, study supervision, preparation of the manuscript, critical review of the manuscript and is also the manuscript guarantor. Acquisition of data was done by ADB. Analysis and interpretation of the data, critical review of the manuscript was done by CS. Analysis and interpretation of the data was done by EASM. Acquisition of data was done by RJLC. Critical review of the manuscript done by AAC-G and TJL. Study concept and design, critical review of the manuscript done by LSW.

Corresponding author

Correspondence to Jason Mackey.

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Ethical approval

The Indiana University Institutional Review Board, the Indiana Network for Patient Care (INPC) board of directors, and Wishard Memorial Hospital approved this study.

Conflict of interest

Dr. Mackey is funded by IUH-VFR-365, IUH/IUSM Strategic Research Initiative, CTSI PDT, NIH LRP, and an Indiana University CTSI KL2 award. A.D. Blatsioris, C. Saha, E.A.S. Moser, and R.J.L. Carter are funded by IUH-VFR-365 and IUH/IUSM Strategic Research Initiative. Drs. Cohen-Gadol, Leipzig, and Williams reports no disclosures.

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Mackey, J., Blatsioris, A.D., Saha, C. et al. Higher Monocyte Count is Associated with 30-Day Case Fatality in Intracerebral Hemorrhage. Neurocrit Care 34, 456–464 (2021). https://doi.org/10.1007/s12028-020-01040-z

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  • DOI: https://doi.org/10.1007/s12028-020-01040-z

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