Main Article Content
Abstract
Background: Haemorrhagic stroke causes high disability and mortality. Moreover, the prevalence is increasing. There is evidence of the involvement of the inflammatory process in haemorrhagic strokes. The neutrophil-lymphocyte ratio (NLR) is a strong and easily assessed marker of inflammation.
Objective: This study aims to determine the NLR during hospital admission as a predictor of neurological deterioration in acute haemorrhagic strokes.
Methods: This study was a prospective cohort study. The subjects were acute haemorrhagic stroke patients treated at the Stroke Unit of the RSUP Dr. Sardjito between March and November 2018. The demographic and laboratory test data, including NLR and National Institutes of Health Stroke Scale (NIHSS) measurement upon admission, were investigated. Logistic regression was performed to identify independent risk factors of neurological deterioration.
Results: A total of 65 haemorrhagic stroke patients were included in this study. There were 21 subjects experiencing neurological deterioration, and 44 subjects did not. In bivariate analysis, there was a significant association between hyperglycaemia and neurological deterioration (RR=3.073; 95%CI=1.772-5.329; p=0.011). Glasgow Coma Scale (GCS) at admission was significantly associated with neurological deterioration (RR=2.732; 95%CI=1.455-5.131; p=0.006) as well as the NLR (RR=3.750; 95%CI=1.229-9.4441; p=0.005). The logistic regression results demonstrated that the variables that independently influenced neurological deterioration were NLR (RR= 4.424; 95%CI=1.196-16.369; p=0.026) and GCS (RR=7.461; 95%CI=1.711-32.526; p=0.007).
Conclusion: High NLR can predict deterioration in acute haemorrhagic stroke.
Keywords
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References
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- Wang J. Preclinical and clinical research on inflammation after intracerebral hemorrhage. Progress in Neurobiology. 2010:92;463–477. Available from: https://doi.org/10.1016/j.pneurobio.2010.08.001.Preclinical.
- Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 2006;5:53–63.
- Wang J, Dore S. Inflammation after intracerebral hemorrhage. J Cereb Blood Flow Metab. 2007;27:894–908.
- Bestue-Cardiel M,Martin-Martinez J, Iturriaga-Heras C, Ara-Callizo JR, Oliveros-Juste A. Leukocytes and primary intracerebral hemorrhage. Rev Neurol. 1999;29:968–971
- Suzuki S, Kelley RE, Dandapani BK, Reyes-Iglesias Y, Dietrich WD, Duncan RC. Acute leukocyte and temperature response in hypertensive intracerebral hemorrhage. Stroke. 1995;26:1020–1023.
- Sun Y, Shoujiang Y, Chongke Z, Zhichao H, Lifang H, Xia Z, Jijun S, Yongjun C, Chun FL. Neutrophil to Lymphocyte Ratio and the Hematoma Volume and Stroke Severity in Acute Intracerebral Hemorrhage Patients. American Journal of Emergency Medicine. 2017; 35; no. 3: 429–433. Available from: DOI: https://doi.org/10.1016/j.ajem.2016.11.037.
- Lattanzi S, Claudia C, Leandro P, Mauro S. Neutrophil-to-Lymphocyte Ratio and Neurological Deterioration Following Acute Cerebral Hemorrhage. 2017; 34: 57489–57494.
- Zahorec R: Ratio of neutrophil to lymphocyte counts – rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102: 5–14.
- Giede-Jeppe, Antje, Tobias B, Stefan TG, Jochen AS, Maximilian IS, Vanessa DB, Hannes L, Philip H, Joji BK, Hagen BH. Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage. Cerebrovascular Diseases. 2017; 44 12; 26–34. Available from DOI: https://doi.org/10.1159/000468996.
- Tao C, Hu X, Wang J, Ma J, Li H, You C. Admission Neutrophil Count and Neutrophil to Lymphocyte Ratio Predict 90-Day Outcome in Intracerebral Hemorrhage. Biomarkers in Medicine. 2017; 11; 1. Available from: DOI: https://doi.org/10.2217/bmm-2016-0187.
- Sastroasmoro, S, Ismael S. Pemilihan subyek penelitian dalam Dasar-dasar Metodologi Penelitian Klinis, Edisi ketiga cetakan kedua., 2010; C.V. Sagung Seto, Jakarta.
- Lattanzi S, Cagnetti C, Bartolini M, Rinaldi C, Angelocola S, Provinciali L, Silvestrini M. Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage. Stroke. 2016; 47; 6: 1654–1657. Available from: DOI: https://doi.org/10.1161/STROKEAHA.116.013627.
- Wang F, Shanyou H, Yong D, Xuefeng J, Li W, Qiuxia L, Xiao W. Neutrophil-to-Lymphocyte Ratio and 30-Day Mortality in Patients with Acute Intracerebral Hemorrhage. Journal of Stroke and Cerebrovascular Diseases. 2015; 25; 1–6: 182–187. Available from: DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.09.013.
- Gong C, Hoff JT, Keep RF. Acute inflammatory reaction following experimental intra- cerebral hemorrhage in rat. Brain Res. 2000; 871:57–65.
- Xue M, Del BMR. Intracortical hemorrhage injury in rats: relationship between blood fractions and brain cell death. Stroke. 2000; 31:1721–1727.
- Tao C, Hu X, Wang J, Ma J, Li H., You C. Admission Neutrophil Count and Neutrophil to Lymphocyte Ratio Predict 90-Day Outcome in Intracerebral Hemorrhage. Biomarkers in Medicine. 2017; 11, no. 1. Available from: DOI: https://doi.org/10.2217/bmm-2016-0187.
- Gusdon, Aaron M., Gino G, Gbambele K, Hediyeh B, Alexander EM, Halinder SM, Babak BN. Neutrophil-Lymphocyte Ratio and Perihematomal Edema Growth in Intracerebral Hemorrhage. Stroke. 2017; 48, no. 9: 2589–2592. Available from: DOI: https://doi.org/10.1161/STROKEAHA.117.018120.
- Parry-Jones, Adrian R, Kamran AA, Mario DN, Craig JS, Andy V, Hiren CP, Andrew TK, Pippa JT. Accuracy and Clinical Usefulness of Intracerebral Hemorrhage Grading Scores: A Direct Comparison in a UK Population. Stroke. 2013; 44 no. 7: 1840–1845. Available from: DOI: https://doi.org/10.1161/STROKEAHA.113.001009.
- Rosenfeld JV dan Lennarson PJ. Coma and brain death dalam Neurology and Clinical Neuroscience, Mosby Elsevier, Philadelphia. 2007. Available from: DOI: https://doi.org/10.1016/B978-0-323-03354-1.50012-2.
References
An, Sang J, Tae JK, Byung-Woo Y. Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. Journal of Stroke. 2017; 19,1: 3–10. Available from: DOI: https://doi.org/10.5853/jos.2016.00864.
Wang J. Preclinical and clinical research on inflammation after intracerebral hemorrhage. Progress in Neurobiology. 2010:92;463–477. Available from: https://doi.org/10.1016/j.pneurobio.2010.08.001.Preclinical.
Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 2006;5:53–63.
Wang J, Dore S. Inflammation after intracerebral hemorrhage. J Cereb Blood Flow Metab. 2007;27:894–908.
Bestue-Cardiel M,Martin-Martinez J, Iturriaga-Heras C, Ara-Callizo JR, Oliveros-Juste A. Leukocytes and primary intracerebral hemorrhage. Rev Neurol. 1999;29:968–971
Suzuki S, Kelley RE, Dandapani BK, Reyes-Iglesias Y, Dietrich WD, Duncan RC. Acute leukocyte and temperature response in hypertensive intracerebral hemorrhage. Stroke. 1995;26:1020–1023.
Sun Y, Shoujiang Y, Chongke Z, Zhichao H, Lifang H, Xia Z, Jijun S, Yongjun C, Chun FL. Neutrophil to Lymphocyte Ratio and the Hematoma Volume and Stroke Severity in Acute Intracerebral Hemorrhage Patients. American Journal of Emergency Medicine. 2017; 35; no. 3: 429–433. Available from: DOI: https://doi.org/10.1016/j.ajem.2016.11.037.
Lattanzi S, Claudia C, Leandro P, Mauro S. Neutrophil-to-Lymphocyte Ratio and Neurological Deterioration Following Acute Cerebral Hemorrhage. 2017; 34: 57489–57494.
Zahorec R: Ratio of neutrophil to lymphocyte counts – rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102: 5–14.
Giede-Jeppe, Antje, Tobias B, Stefan TG, Jochen AS, Maximilian IS, Vanessa DB, Hannes L, Philip H, Joji BK, Hagen BH. Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage. Cerebrovascular Diseases. 2017; 44 12; 26–34. Available from DOI: https://doi.org/10.1159/000468996.
Tao C, Hu X, Wang J, Ma J, Li H, You C. Admission Neutrophil Count and Neutrophil to Lymphocyte Ratio Predict 90-Day Outcome in Intracerebral Hemorrhage. Biomarkers in Medicine. 2017; 11; 1. Available from: DOI: https://doi.org/10.2217/bmm-2016-0187.
Sastroasmoro, S, Ismael S. Pemilihan subyek penelitian dalam Dasar-dasar Metodologi Penelitian Klinis, Edisi ketiga cetakan kedua., 2010; C.V. Sagung Seto, Jakarta.
Lattanzi S, Cagnetti C, Bartolini M, Rinaldi C, Angelocola S, Provinciali L, Silvestrini M. Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage. Stroke. 2016; 47; 6: 1654–1657. Available from: DOI: https://doi.org/10.1161/STROKEAHA.116.013627.
Wang F, Shanyou H, Yong D, Xuefeng J, Li W, Qiuxia L, Xiao W. Neutrophil-to-Lymphocyte Ratio and 30-Day Mortality in Patients with Acute Intracerebral Hemorrhage. Journal of Stroke and Cerebrovascular Diseases. 2015; 25; 1–6: 182–187. Available from: DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.09.013.
Gong C, Hoff JT, Keep RF. Acute inflammatory reaction following experimental intra- cerebral hemorrhage in rat. Brain Res. 2000; 871:57–65.
Xue M, Del BMR. Intracortical hemorrhage injury in rats: relationship between blood fractions and brain cell death. Stroke. 2000; 31:1721–1727.
Tao C, Hu X, Wang J, Ma J, Li H., You C. Admission Neutrophil Count and Neutrophil to Lymphocyte Ratio Predict 90-Day Outcome in Intracerebral Hemorrhage. Biomarkers in Medicine. 2017; 11, no. 1. Available from: DOI: https://doi.org/10.2217/bmm-2016-0187.
Gusdon, Aaron M., Gino G, Gbambele K, Hediyeh B, Alexander EM, Halinder SM, Babak BN. Neutrophil-Lymphocyte Ratio and Perihematomal Edema Growth in Intracerebral Hemorrhage. Stroke. 2017; 48, no. 9: 2589–2592. Available from: DOI: https://doi.org/10.1161/STROKEAHA.117.018120.
Parry-Jones, Adrian R, Kamran AA, Mario DN, Craig JS, Andy V, Hiren CP, Andrew TK, Pippa JT. Accuracy and Clinical Usefulness of Intracerebral Hemorrhage Grading Scores: A Direct Comparison in a UK Population. Stroke. 2013; 44 no. 7: 1840–1845. Available from: DOI: https://doi.org/10.1161/STROKEAHA.113.001009.
Rosenfeld JV dan Lennarson PJ. Coma and brain death dalam Neurology and Clinical Neuroscience, Mosby Elsevier, Philadelphia. 2007. Available from: DOI: https://doi.org/10.1016/B978-0-323-03354-1.50012-2.