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Zhang H, Deng J, Cai Z, He Y. Association between white blood cells and ultra-early hematoma growth in patients with spontaneous intracerebral hemorrhage. Heliyon 2024; 10:e28554. [PMID: 38586340 PMCID: PMC10998103 DOI: 10.1016/j.heliyon.2024.e28554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
Background Ultra-early inflammatory reaction after spontaneous intracerebral hemorrhage (sICH) plays an important role in the coagulation process and is closely related to early hematoma expansion. However, the relationship between ultra-early hematoma growth (uHG) and ultra-early inflammatory reaction remains unknown. Objective To evaluate the association between ultra-early inflammatory indicators and uHG in patients with sICH. Methods We retrospectively included 225 patients with acute sICH who were divided into the uHG ≤4.7 ml/h group and the uHG >4.7 ml/h group, respectively. The uHG was defined as hematoma volume (milliliter) at the primary computed tomography (CT) scan divided by time (hour) from onset to the performance of primary CT within 6 h after onset. The white blood cells (WBC), blood hypersensitive C-reactive protein, National Institutes of Health Stroke Scale (NIHSS) score and other related baseline data were collected and compared between the two groups. The multivariate regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the independent risk factors for uHG >4.7 ml/h. Results NIHSS score and WBC were independent risk factors for uHG in patients with acute sICH (OR 1.188, 95% CI: 1.111-1.271, p < 0.001; OR 1.151, 95% CI: 1.018-1.300, p = 0.024; respectively). The area under curve of ROC for WBC and NIHSS score was 0.658 and 0.754, respectively (all p < 0.001), while the WBC combined with NIHSS score was 0.773 (p < 0.001). Conclusion WBC count within 6h after onset might be an independent risk factor for the increase of uHG in patients with sICH.
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Affiliation(s)
- Hui Zhang
- Department of Neurology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
- Department of Neurology, The First Affiliated Hospital of Southern University of Science and Technology (Shenzhen People's Hospital), Shenzhen Guangdong, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Jian Deng
- Department of Neurology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
- Department of Neurology, The First Affiliated Hospital of Southern University of Science and Technology (Shenzhen People's Hospital), Shenzhen Guangdong, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Zhili Cai
- Department of Neurology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
- Department of Neurology, The First Affiliated Hospital of Southern University of Science and Technology (Shenzhen People's Hospital), Shenzhen Guangdong, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Yitao He
- Department of Neurology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
- Department of Neurology, The First Affiliated Hospital of Southern University of Science and Technology (Shenzhen People's Hospital), Shenzhen Guangdong, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People's Hospital, Shenzhen, Guangdong, China
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Liu M, Wang D, Xu L, Pan Y, Huang H, Li M, Liu Q. Group 2 innate lymphoid cells suppress neuroinflammation and brain injury following intracerebral hemorrhage. J Cereb Blood Flow Metab 2024; 44:355-366. [PMID: 37933727 PMCID: PMC10870958 DOI: 10.1177/0271678x231208168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 11/08/2023]
Abstract
Intracerebral hemorrhage (ICH) mobilizes circulating leukocytes that contribute to neuroinflammation and neural injury. However, little is known about the endogenous regulatory immune mechanisms to restrict neuroinflammation following ICH. We examined the role of group 2 innate lymphoid cells (ILC2) that are a specialized subset of innate immune modulators in a mouse model of ICH. We found accumulation of ILC2 in the brain following acute ICH and a concomitant increase of ILC2 within the peripheral lymph nodes. Depletion of ILC2 exacerbated neurodeficits and brain edema after ICH in male and female mice. This aggravated ICH injury was accompanied by augmented microglia activity and leukocyte infiltration. In contrast, expansion of ILC2 using IL-33 led to reduced ICH injury, microglia activity and leukocyte infiltration. Notably, elimination of microglia using a colony stimulating factor 1 receptor inhibitor diminished the exacerbation of ICH injury induced by depletion of ILC2. Brain-infiltrating ILC2 had upregulation of IL-13 after ICH. Results from in vitro assays revealed that ILC2 suppressed thrombin-induced inflammatory activity in microglia-like BV2 cells. Thus, our findings demonstrate that ILC2 suppress neuroinflammation and acute ICH injury.
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Affiliation(s)
- Mingming Liu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Institute of Immunology, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Tianjin Medical University General Hospital, Tianjin, China
| | - Danni Wang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Institute of Immunology, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Tianjin Medical University General Hospital, Tianjin, China
- Department of Neurology, The Second Hospital of Shandong University, Jinan, China
| | - Lin Xu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Institute of Immunology, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Pan
- Department of Neurology, Tianjin Neurological Institute, Tianjin Institute of Immunology, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Tianjin Medical University General Hospital, Tianjin, China
| | - Huachen Huang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Institute of Immunology, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Tianjin Medical University General Hospital, Tianjin, China
| | - Minshu Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Institute of Immunology, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiang Liu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Institute of Immunology, State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Tianjin Medical University General Hospital, Tianjin, China
- Department of Neurology, The Second Hospital of Shandong University, Jinan, China
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3
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Guo P, Zou W. Neutrophil-to-lymphocyte ratio, white blood cell, and C-reactive protein predicts poor outcome and increased mortality in intracerebral hemorrhage patients: a meta-analysis. Front Neurol 2024; 14:1288377. [PMID: 38288330 PMCID: PMC10824245 DOI: 10.3389/fneur.2023.1288377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Objective Inflammation participates in the pathology and progression of secondary brain injury after intracerebral hemorrhage (ICH). This meta-analysis intended to explore the prognostic role of inflammatory indexes, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell (WBC), and C-reactive protein (CRP) in ICH patients. Methods Embase, PubMed, Web of Science, and Cochrane Library were searched until June 2023. Two outcomes, including poor outcome and mortality were extracted and measured. Odds ratio (OR) and 95% confidence interval (CI) were presented for outcome assessment. Results Forty-six studies with 25,928 patients were included in this meta-analysis. The high level of NLR [OR (95% CI): 1.20 (1.13-1.27), p < 0.001], WBC [OR (95% CI): 1.11 (1.02-1.21), p = 0.013], and CRP [OR (95% CI): 1.29 (1.08-1.54), p = 0.005] were related to poor outcome in ICH patients. Additionally, the high level of NLR [OR (95% CI): 1.06 (1.02-1.10), p = 0.001], WBC [OR (95% CI): 1.39 (1.16-1.66), p < 0.001], and CRP [OR (95% CI): 1.02 (1.01-1.04), p = 0.009] were correlated with increased mortality in ICH patients. Nevertheless, PLR was not associated with poor outcome [OR (95% CI): 1.00 (0.99-1.01), p = 0.749] or mortality [OR (95% CI): 1.00 (0.99-1.01), p = 0.750] in ICH patients. The total score of risk of bias assessed by Newcastle-Ottawa Scale criteria ranged from 7-9, which indicated the low risk of bias in the included studies. Publication bias was low, and stability assessed by sensitivity analysis was good. Conclusion This meta-analysis summarizes that the high level of NLR, WBC, and CRP estimates poor outcome and higher mortality in ICH patients.
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Affiliation(s)
- Peixin Guo
- Integrated Traditional Chinese and Western Medicine, Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Wei Zou
- Third Ward of Acupuncture Department, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
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4
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Liu L, Dong X, Liu Y, Wang S, Wei L, Duan L, Zhang Q, Zhang K. Predictive value of white blood cell to hemoglobin ratio for 30-day mortality in patients with severe intracerebral hemorrhage. Front Neurol 2024; 14:1222717. [PMID: 38283683 PMCID: PMC10811233 DOI: 10.3389/fneur.2023.1222717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/10/2023] [Indexed: 01/30/2024] Open
Abstract
Aim To explore the predictive value of white blood cell to hemoglobin ratio (WHR) for 30-day mortality in patients with intracerebral hemorrhage (ICH). Methods In this cohort study, 2,848 patients with ICH were identified in the Medical Information Mart for Intensive Care (MIMIC)-III and MIMIC-IV. Least absolute shrinkage and selection operator (LASSO) regression screened covariates of 30-day mortality of ICH patients. COX regression analysis was used to study the association of different levels of WHR, white blood cell (WBC), and hemoglobin (Hb) with 30-day mortality. The median follow-up time was 30 (20.28, 30.00) days. Results In total, 2,068 participants survived at the end of the follow-up. WHR was negatively correlated with the Glasgow Coma Score (GCS) (spearman correlation coefficient = -0.143, p < 0.001), and positively associated with the Sepsis-related Organ Failure Assessment (SOFA) score (spearman correlation coefficient = 0.156, p < 0.001), quick SOFA (qSOFA) score (spearman correlation coefficient = 0.156, p < 0.001), and Simplified Acute Physiology Score II (SAPS-II) (spearman correlation coefficient = 0.213, p < 0.001). After adjusting for confounders, WHR >0.833 (HR = 1.64, 95%CI: 1.39-1.92) and WBC >10.9 K/uL (HR = 1.49, 95%CI: 1.28-1.73) were associated with increased risk of 30-day mortality of patients with ICH. The area under the curve (AUC) value of the prediction model based on WHR and other predictors was 0.78 (95%CI: 0.77-0.79), which was higher than SAPSII (AUC = 0.75, 95%CI: 0.74-0.76), SOFA score (AUC = 0.69, 95%CI: 0.68-0.70) and GCS (AUC = 0.59, 95%CI: 0.57-0.60). Conclusion The level of WHR was associated with 30-day mortality in patients with severe ICH, and the WHR-based prediction model might provide a tool to quickly predict 30-day mortality in patients with ICH.
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Affiliation(s)
| | | | | | | | | | | | | | - Kun Zhang
- Department of Neurosurgery, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China
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Zhang G, Lu J, Zheng J, Mei S, Li H, Zhang X, Ping A, Gao S, Fang Y, Yu J. Spi1 regulates the microglial/macrophage inflammatory response via the PI3K/AKT/mTOR signaling pathway after intracerebral hemorrhage. Neural Regen Res 2024; 19:161-170. [PMID: 37488863 PMCID: PMC10479839 DOI: 10.4103/1673-5374.375343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 07/26/2023] Open
Abstract
Preclinical and clinical studies have shown that microglia and macrophages participate in a multiphasic brain damage repair process following intracerebral hemorrhage. The E26 transformation-specific sequence-related transcription factor Spi1 regulates microglial/macrophage commitment and maturation. However, the effect of Spi1 on intracerebral hemorrhage remains unclear. In this study, we found that Spi1 may regulate recovery from the neuroinflammation and neurofunctional damage caused by intracerebral hemorrhage by modulating the microglial/macrophage transcriptome. We showed that high Spi1 expression in microglia/macrophages after intracerebral hemorrhage is associated with the activation of many pathways that promote phagocytosis, glycolysis, and autophagy, as well as debris clearance and sustained remyelination. Notably, microglia with higher levels of Spi1 expression were characterized by activation of pathways associated with a variety of hemorrhage-related cellular processes, such as complement activation, angiogenesis, and coagulation. In conclusion, our results suggest that Spi1 plays a vital role in the microglial/macrophage inflammatory response following intracerebral hemorrhage. This new insight into the regulation of Spi1 and its target genes may advance our understanding of neuroinflammation in intracerebral hemorrhage and provide therapeutic targets for patients with intracerebral hemorrhage.
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Affiliation(s)
- Guoqiang Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jianan Lu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jingwei Zheng
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Shuhao Mei
- Department of Neurosurgery, Huashan Hospital of Fudan University School of Medicine, Shanghai, China
| | - Huaming Li
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiaotao Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - An Ping
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Shiqi Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jun Yu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang Province, China
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou, Zhejiang Province, China
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6
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Kirby C, Barrington J, Sondag L, Loan JJ, Schreuder FH, McColl BW, Klijn CJ, Al-Shahi Salman R, Samarasekera N. Association between circulating inflammatory biomarkers and functional outcome or perihaematomal oedema after ICH: a systematic review & meta-analysis. Wellcome Open Res 2023; 8:239. [PMID: 38037559 PMCID: PMC10687391 DOI: 10.12688/wellcomeopenres.19187.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Background Currently, there are no specific medical treatments for intracerebral haemorrhage (ICH), but the inflammatory response may provide a potential route to treatment. Given the known effects of acute brain injury on peripheral immunity, we hypothesised that inflammatory biomarkers in peripheral blood may be associated with clinical outcome following ICH, as well as perihaematomal oedema (PHO), which is an imaging marker of the neuroinflammatory response. Methods We searched OVID Medline and EMBASE on 07 April 2021 for studies of humans with ICH measuring an inflammatory biomarker in peripheral blood and PHO or clinical outcome. Risk of bias was assessed both by using a scale comprising features of the Newcastle-Ottawa Assessment Scale, STROBE-ME and REMARK guidelines, and for studies included in meta-analysis, also by the QUIPS tool.We used random effects meta-analysis to pool standardised mean differences (SMD) if ≥1 study quantified the association between identical biomarkers and measures of PHO or functional outcome. Results Of 8,615 publications, 16 examined associations between 21 inflammatory biomarkers and PHO (n=1,299 participants), and 93 studies examined associations between ≥1 biomarker and clinical outcome (n=17,702 participants). Overall, 20 studies of nine biomarkers (n=3,199) met criteria for meta-analysis of associations between inflammatory biomarkers and clinical outcome. Death or dependency (modified Rankin Scale (mRS) 3‒6) 90 days after ICH was associated with higher levels of fibrinogen (SMD 0.32; 95%CI [0.04, 0.61]; p=0.025), and high mobility group box protein 1 (HMGB1) (SMD 1.67; 95%CI [0.05, 3.30]; p=0.04). Higher WBC was associated with death or dependency at 90 days (pooled SMD 0.27; 95% CI [0.11, 0.44]; p=0.001; but the association was no longer significant when the analysis was restricted to studies with a low risk of bias (pooled SMD 0.22; 95% CI -0.04-0.48). Higher CRP seemed to be associated with death or dependency at 90 days (pooled SMD 0.80; 95% CI [0.44, 1.17]; p<0.0001) but this association was no longer significant when adjusted OR were pooled (OR 0.99 (95% CI 0.98-1.01)). Conclusions Higher circulating levels of, fibrinogen and HMGB1 are associated with poorer outcomes after ICH. This study highlights the clinical importance of the inflammatory response to ICH and identifies additional research needs in determining if these associations are mediated via PHO and are potential therapeutic targets. Registration PROSPERO ( CRD42019132628; 28/05/2019).
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Affiliation(s)
- Caoimhe Kirby
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
- Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
- UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Jack Barrington
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
- Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
- UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - James J.M. Loan
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
- Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
- UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Floris H.B.M. Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - Barry W. McColl
- Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
- UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Catharina J.M. Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Neshika Samarasekera
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
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7
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Lv XN, Li ZQ, Li Q. Blood-Based Biomarkers in Intracerebral Hemorrhage. J Clin Med 2023; 12:6562. [PMID: 37892701 PMCID: PMC10607631 DOI: 10.3390/jcm12206562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is one of the most lethal subtypes of stroke, associated with high morbidity and mortality. Prevention of hematoma growth and perihematomal edema expansion are promising therapeutic targets currently under investigation. Despite recent improvements in the management of ICH, the ideal treatments are still to be determined. Early stratification and triage of ICH patients enable the adjustment of the standard of care in keeping with the personalized medicine principles. In recent years, research efforts have been concentrated on the development and validation of blood-based biomarkers. The benefit of looking for blood candidate markers is obvious because of their acceptance in terms of sample collection by the general population compared to any other body fluid. Given their ease of accessibility in clinical practice, blood-based biomarkers have been widely used as potential diagnostic, predictive, and prognostic markers. This review identifies some relevant and potentially promising blood biomarkers for ICH. These blood-based markers are summarized by their roles in clinical practice. Well-designed and large-scale studies are required to validate the use of all these biomarkers in the future.
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Affiliation(s)
- Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (X.-N.L.); (Z.-Q.L.)
| | - Zuo-Qiao Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (X.-N.L.); (Z.-Q.L.)
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (X.-N.L.); (Z.-Q.L.)
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
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8
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Stephens R, Grainger JR, Smith CJ, Allan SM. Systemic innate myeloid responses to acute ischaemic and haemorrhagic stroke. Semin Immunopathol 2023; 45:281-294. [PMID: 36346451 PMCID: PMC9641697 DOI: 10.1007/s00281-022-00968-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
Acute ischaemic and haemorrhagic stroke account for significant disability and morbidity burdens worldwide. The myeloid arm of the peripheral innate immune system is critical in the immunological response to acute ischaemic and haemorrhagic stroke. Neutrophils, monocytes, and dendritic cells (DC) contribute to the evolution of pathogenic local and systemic inflammation, whilst maintaining a critical role in ongoing immunity protecting against secondary infections. This review aims to summarise the key alterations to myeloid immunity in acute ischaemic stroke, intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH). By integrating clinical and preclinical research, we discover how myeloid immunity is affected across multiple organ systems including the brain, blood, bone marrow, spleen, and lung, and evaluate how these perturbations associate with real-world outcomes including infection. These findings are placed in the context of the rapidly developing field of human immunology, which offers a wealth of opportunity for further research.
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Affiliation(s)
- Ruth Stephens
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - John R Grainger
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Craig J Smith
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Stuart M Allan
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK.
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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9
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Li Y, Yang X, Zhou H, Hui X, Li H, Zheng J. A high neutrophil-to-platelet ratio is associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage: a retrospective study. BMC Neurol 2023; 23:27. [PMID: 36653741 PMCID: PMC9847168 DOI: 10.1186/s12883-023-03055-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Early hematoma expansion (HE) occurs in 20 to 40% of spontaneous intracerebral hemorrhage (ICH) patients and is a primary determinant of early deterioration and poor prognosis. Previous studies have shown that inflammation is a major pathological feature of ICH, and the neutrophil-to-platelet ratio (NPR) is a marker of systemic inflammation. Therefore, we aimed to assess the association between the NPR and HE in ICH patients. METHODS We retrospectively collected and analyzed data from ICH patients who received treatment at our institution from January 2018 to November 2019. The NPR was calculated from the admission blood test. Brain computed tomography (CT) scans were performed at admission and repeated within 24 h. Hematoma growth was defined as relative growth > 33% or absolute growth > 6 ml. RESULTS A total of 317 patients were enrolled in our study. Multivariate logistic regression analysis indicated that the NPR was an independent predictor of HE [odds ratio (OR) = 1.742; 95% CI: 1.508-2.012, p < 0.001]. Receiver operating characteristic (ROC) curve analysis revealed that the NPR could predict HE, with an area under the curve of 0.838 (95% CI, 0.788-0.888, p < 0.001). The best predictive cut-off of the NPR for HE was 5.47 (sensitivity, 75.3%; specificity, 77.6%). CONCLUSIONS A high NPR was associated with an increased risk of HE in patients with ICH.
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Affiliation(s)
- Yujian Li
- grid.412901.f0000 0004 1770 1022Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, 610041 Chengdu, P.R. China
| | - Xiang Yang
- grid.412901.f0000 0004 1770 1022Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, 610041 Chengdu, P.R. China
| | - Huiqing Zhou
- grid.460079.cDepartment of Intensive Care Unit, Fourth People’s Hospital of Sichuan Province, Chengdu, P.R. China
| | - Xuhui Hui
- grid.412901.f0000 0004 1770 1022Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, 610041 Chengdu, P.R. China
| | - Hao Li
- grid.412901.f0000 0004 1770 1022Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, 610041 Chengdu, P.R. China
| | - Jun Zheng
- grid.412901.f0000 0004 1770 1022Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, 610041 Chengdu, P.R. China
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Rendevski V, Aleksovski B, Mihajlovska Rendevska A, Hadzi-Petrushev N, Manusheva N, Shuntov B, Gjorgoski I. Inflammatory and oxidative stress markers in intracerebral hemorrhage: Relevance as prognostic markers for quantification of the edema volume. Brain Pathol 2022; 33:e13106. [PMID: 35762501 PMCID: PMC10041164 DOI: 10.1111/bpa.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 01/24/2023] Open
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 × 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.
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Affiliation(s)
- Vladimir Rendevski
- Medical Faculty, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Boris Aleksovski
- Faculty of Natural Sciences and Mathematics-Skopje, Institute of Biology, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | | | - Nikola Hadzi-Petrushev
- Faculty of Natural Sciences and Mathematics-Skopje, Institute of Biology, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Nensi Manusheva
- Medical Faculty, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Blagoj Shuntov
- Medical Faculty, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Icko Gjorgoski
- Faculty of Natural Sciences and Mathematics-Skopje, Institute of Biology, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
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Lusk JB, Quinones QJ, Staats JS, Weinhold KJ, Grossi PM, Nimjee SM, Laskowitz DT, James ML. Coupling hematoma evacuation with immune profiling for analysis of neuroinflammation after primary intracerebral hemorrhage: a pilot study. World Neurosurg 2022; 161:162-168. [PMID: 35217228 DOI: 10.1016/j.wneu.2022.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the use and feasibility of an integrated hematoma evacuation/tissue preservation system coupled with immune profiling to assess human ex vivo immune cell populations from brain hematoma samples after intracerebral hemorrhage (ICH) METHODS: In this non-randomized, non-controlled pilot/feasibility study of 7 patients with primary supratentorial ICH, a hematoma evacuation device and integrated tissue preservation system were utilized to obtain hematoma samples during surgical evacuation. Samples were processed, cryopreserved, and analyzed using flow cytometry to determine the relative distribution of immune cell populations compared to peripheral blood mononuclear cells from healthy control subjects RESULTS: This study demonstrates proof of concept for an integrated hematoma evacuation and sample preservation system to collect human brain hematoma samples for flow cytometry analysis after acute human ICH. Hematoma samples in our preliminary analysis demonstrated different makeup of white blood cells than peripheral blood from healthy controls. CONCLUSIONS Flow cytometry analysis of hematoma samples in ICH demonstrates the potential to provide important insights into neuroinflammation associated with ICH.
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Affiliation(s)
- Jay B Lusk
- School of Medicine, Duke University, Durham, NC; Fuqua School of Business, Duke University, Durham, NC.
| | | | - Janet S Staats
- Duke Immune Profiling Core, Department of Surgery, Duke University, Durham, NC
| | - Kent J Weinhold
- Duke Immune Profiling Core, Department of Surgery, Duke University, Durham, NC
| | | | - Shahid M Nimjee
- Department of Neurological Surgery, The Ohio State University, Columbus, OH
| | - Daniel T Laskowitz
- Department of Anesthesiology, Duke University, Durham NC; Department of Neurology, Duke University, Durham NC
| | - Michael L James
- Department of Anesthesiology, Duke University, Durham NC; Department of Neurology, Duke University, Durham NC
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12
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Machine Learning-Based Approaches for Prediction of Patients’ Functional Outcome and Mortality after Spontaneous Intracerebral Hemorrhage. J Pers Med 2022; 12:jpm12010112. [PMID: 35055424 PMCID: PMC8778760 DOI: 10.3390/jpm12010112] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 12/04/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (SICH) has been common in China with high morbidity and mortality rates. This study aims to develop a machine learning (ML)-based predictive model for the 90-day evaluation after SICH. We retrospectively reviewed 751 patients with SICH diagnosis and analyzed clinical, radiographic, and laboratory data. A modified Rankin scale (mRS) of 0–2 was defined as a favorable functional outcome, while an mRS of 3–6 was defined as an unfavorable functional outcome. We evaluated 90-day functional outcome and mortality to develop six ML-based predictive models and compared their efficacy with a traditional risk stratification scale, the intracerebral hemorrhage (ICH) score. The predictive performance was evaluated by the areas under the receiver operating characteristic curves (AUC). A total of 553 patients (73.6%) reached the functional outcome at the 3rd month, with the 90-day mortality rate of 10.2%. Logistic regression (LR) and logistic regression CV (LRCV) showed the best predictive performance for functional outcome (AUC = 0.890 and 0.887, respectively), and category boosting presented the best predictive performance for the mortality (AUC = 0.841). Therefore, ML might be of potential assistance in the prediction of the prognosis of SICH.
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13
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Mureșan EM, Golea A, Vesa Ș, Lenghel M, Csutak C, Perju‑Dumbravă L. Emergency department point‑of‑care biomarkers and day 90 functional outcome in spontaneous intracerebral hemorrhage: A single‑center pilot study. Exp Ther Med 2022; 23:200. [PMID: 35126703 PMCID: PMC8794556 DOI: 10.3892/etm.2022.11123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (sICH) results in high morbidity and mortality rates, thus identifying strategies for timely prognosis and treatment is important. The present study aimed to analyze the relationship between emergency department point-of-care (POC) blood biomarkers and day 90 functional outcome (FO) in patients with acute (<8 h) sICH. On-site POC determinations, including complete blood count, glucose, cardiac troponin I, D-dimer and C-reactive protein, and derived inflammatory indexes were performed for a cohort of 35 patients. The primary endpoint was a favorable day 90 FO (modified Rankin Score ≤3). Secondary endpoints included early neurological worsening (ENW), day 7/discharge neurological impairment, day 90 independence assessment (Barthel Index <60), hematoma enlargement and perihematomal edema (PHE) growth. A favorable three-month FO was reported in 16 (46%) participants. Older age, previous history of ischemic stroke and initial imagistic parameters, including intraventricular hemorrhage, enlarged contralateral ventricle and cerebral atrophy, significantly predicted an unfavorable FO. The admission D-dimer similarly predicted day 90 FO and the independence status, along with ENW and a more severe day 7/discharge neurological status. The D-dimer also correlated with the initial neurological status and PHE. PHE growth correlated with granulocytes, systemic immune-inflammation index and glycemia. The results suggested that a lower admission D-dimer could indicate an improved day 90 FO of patients with sICH, while also anticipating the development of PHE growth and ENW.
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Affiliation(s)
- Eugenia-Maria Mureșan
- Department of Neurosciences, Faculty of Medicine, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Adela Golea
- Department of Surgery, Emergency Medicine Discipline, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400006 Cluj‑Napoca, Romania
| | - Ștefan Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400349 Cluj‑Napoca, Romania
| | - Manuela Lenghel
- Department of Surgical Specialties, Radiology Discipline, ‘Iuliu Hațieganu’, University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Csaba Csutak
- Department of Surgical Specialties, Radiology Discipline, ‘Iuliu Hațieganu’, University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Lăcrămioara Perju‑Dumbravă
- Department of Neurosciences, Faculty of Medicine, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
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14
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Shtaya A, Bridges LR, Williams R, Trippier S, Zhang L, Pereira AC, Nicoll JAR, Boche D, Hainsworth AH. Innate Immune Anti-Inflammatory Response in Human Spontaneous Intracerebral Hemorrhage. Stroke 2021; 52:3613-3623. [PMID: 34281379 PMCID: PMC7611898 DOI: 10.1161/strokeaha.121.034673] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/19/2021] [Indexed: 01/02/2023]
Abstract
Background and Purpose Spontaneous intracerebral hemorrhage (sICH) is a common form of hemorrhagic stroke, with high mortality and morbidity. Pathophysiological mechanisms in sICH are poorly understood and treatments limited. Neuroinflammation driven by microglial-macrophage activation contributes to brain damage post-sICH. We aim to test the hypothesis that an anti-inflammatory (repair) process occurs in parallel with neuroinflammation in clinical sICH. Methods We performed quantitative analysis of immunohistochemical markers for microglia and macrophages (Iba1, CD68, TMEM119, CD163, and CD206) in brain tissue biospecimens 1 to 12 days post-sICH and matched control cases. In a parallel, prospective group of patients, we assayed circulating inflammatory markers (CRP [C-reactive protein], total white cell, and monocyte count) over 1 to 12 days following sICH. Results In 27 supratentorial sICH cases (n=27, median [interquartile range] age: 59 [52–80.5], 14F/13M) all microglia-macrophage markers increased post-sICH, relative to control brains. Anti-inflammatory markers (CD163 and CD206) were elevated alongside proinflammatory markers (CD68 and TMEM119). CD163 increased progressively post-sICH (15.0-fold increase at 7–12 days, P<0.001). CD206 increased at 3 to 5 days (5.2-fold, P<0.001) then returned to control levels at 7 to 12 days. The parenchymal immune response combined brain-derived microglia (TMEM119 positive) and invading monocyte-derived macrophages (CD206 positive). In a prospective sICH patient cohort (n=26, age 74 [66–79], National Institutes of Health Stroke Scale on admission: 8 [4–17]; 14F/12M) blood CRP concentration and monocyte density (but not white blood cell) increased post-sICH. CRP increased from 0 to 2 to 3 to 5 days (8.3-fold, P=0.020) then declined at 7 to 12 days. Monocytes increased from 0 to 2 to 3 to 5 days (1.8-fold, P<0.001) then declined at 7 to 12 days. Conclusions An anti-inflammatory pathway, enlisting native microglia and blood monocytes, occurs alongside neuroinflammation post-sICH. This novel pathway offers therapeutic targets and a window of opportunity (3–5 days post-sICH) for delivery of therapeutics via invading monocytes.
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Affiliation(s)
- Anan Shtaya
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Leslie R Bridges
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
- Department of Cellular Pathology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Rebecca Williams
- Neurology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Trippier
- Neurology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Liqun Zhang
- Neurology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Anthony C Pereira
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
- Neurology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - James AR Nicoll
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Delphine Boche
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Atticus H Hainsworth
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
- Neurology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
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15
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Li J, Yuan Y, Liao X, Yu Z, Li H, Zheng J. Prognostic Significance of Admission Systemic Inflammation Response Index in Patients With Spontaneous Intracerebral Hemorrhage: A Propensity Score Matching Analysis. Front Neurol 2021; 12:718032. [PMID: 34630289 PMCID: PMC8497988 DOI: 10.3389/fneur.2021.718032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/13/2021] [Indexed: 02/05/2023] Open
Abstract
Intracerebral hemorrhage (ICH) accounts for ~15% of all strokes and is associated with high mortality and disability rates. The systemic inflammation response index (SIRI) is a novel systemic inflammatory marker based on peripheral neutrophil, monocyte, and lymphocyte counts. This study aimed to evaluate the prognostic significance of admission SIRI in patients with spontaneous ICH and compare its predictive ability with that of the neutrophil-to-lymphocyte ratio (NLR). This retrospective study was conducted based on a prospectively collected database of patients with ICH between June 2016 and January 2019. Propensity score matching (PSM) was conducted to adjust for potential imbalances in the clinical parameters. A total of 403 patients were included in the original cohort. The optimal SIRI cut-off value was 2.76. After 1:1 PSM based on potential confounding variables, a new cohort containing 262 patients was established for further analysis. In the original cohort, SIRI served as an independent predictor of 3-month functional outcome [odds ratio (OR), 1.302; 95% CI, 1.120–1.512; p = 0.001] and 1-month mortality (OR, 1.072; 95% CI, 1.020–1.126; p = 0.006), while NLR was independently associated with only 3-month functional outcomes (OR, 1.051; 95% CI, 1.004–1.100; p = 0.031) and not 1-month mortality. The same applied to the PSM cohort. Receiver operating characteristic analyses and predictive models indicated that in most instances, SIRI was superior to NLR and their components in predicting the outcomes of patients with ICH. Our study found that SIRI is determined to be an independent predictive indicator for ICH patients in 3-month functional outcomes and 1-month mortality. The prognostic predictive ability of SIRI was stronger than that of NLR.
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Affiliation(s)
- Junhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yunbo Yuan
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xiang Liao
- Department of Cardiology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Zhiyuan Yu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hao Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
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16
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Mureşan EM, Golea A, Bolboacă SD, Perju-Dumbravă L. Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting. Med Pharm Rep 2021; 94:307-317. [PMID: 34430852 DOI: 10.15386/mpr-1783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/08/2021] [Accepted: 04/01/2021] [Indexed: 01/17/2023] Open
Abstract
Background and aims Stroke is a worldwide leading cause of death and disability and spontaneous intracerebral hemorrhage (sICH) has significant economic and social impact, regardless of recent efforts towards outcome-bettering acute interventions. The aim of the study was to assess the feasibility of a prospective observational research regarding point-of-care (POC) biomarkers in sICH, conducted in a level one emergency department (ED). Methods Patients with acute (<8 hours) sICH were enrolled in this study. Patients presenting a Glasgow Coma Scale score <8, secondary causes of intracerebral hemorrhage, seizures, recent ischemic events, known thromboembolic disease, anticoagulant treatment, severe pre-stroke disability, terminal disease, scheduled neurosurgery/hemostatic treatment were excluded. Feasibility was defined as ED inclusion and follow-up rates, time-to-inclusion, and frequency of missing data. Baseline demographic, imaging and POC biochemical status of the study group were documented, including inflammatory (complete blood count, C-reactive protein), metabolic (glucose, hepatic, and renal function) and cardiovascular markers (cardiac troponin I, D-dimer). Results The inclusion rate was 2.16 patients/month with a final sample of 35 patients out of 239 potentially eligible patients. The median time from symptom onset to ED presentation was 128 minutes (IQR 96-239), with 21/35 patients having presented within the first 3 hours from ictus. Median times between symptoms' onset to Computer Tomography (CT) scan and ED presentation to CT scan were 170 minutes (IQR 126-317) and 25 minutes (IQR 17-62), respectively. The median time from patient's presentation to CBC result was 12 minutes (IQR 6.5-20), with 21/35 study participants having the results available within 15 minutes from ED arrival. The median cohort age was 72-years, with a 19/16 male/female ratio. Hypertension was the most frequent risk factor (77%), along with ischemic heart disease (31%) and diabetes (29%). One-third of the hypertensive patients did not undergo blood pressure lowering treatment. Median values of POC biomarkers on ED admission were within normal range. Conclusions It was feasible to determine point-of-care biomarkers in spontaneous intracerebral hemorrhage on admission in ED, despite the urgency of the medical condition.
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Affiliation(s)
- Eugenia-Maria Mureşan
- Department of Neurosciences, Iuliu Hatieganu Univesrity of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adela Golea
- Department of Surgery, Emergency Medicine Division, Iuliu Hatieganu Univesrity of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- Department of Medical Education, Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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17
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CSF and serum inflammatory response and association with outcomes in spontaneous intracerebral hemorrhage with intraventricular extension: an analysis of the CLEAR-III Trial. J Neuroinflammation 2021; 18:179. [PMID: 34419101 PMCID: PMC8380363 DOI: 10.1186/s12974-021-02224-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) results in a cascade of inflammatory cell activation with recruitment of peripheral leukocytes to the brain parenchyma and surrounding the hematoma. We hypothesized that in patients with ICH and intraventricular hemorrhage (IVH), a robust cerebrospinal fluid (CSF) inflammatory response occurs with leukocyte subtypes being affected by alteplase treatment and contributing to outcomes. Methods Serum and CSF cell counts from patients in the phase 3 Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III) trial were analyzed. CSF leukocytes were corrected for the presence of red blood cells. Trends in cell counts were plotted chronologically. Associations were evaluated between serum and CSF leukocyte subtypes and adjudicated functional outcome (modified Rankin Scale; mRS) at 30 and 180 days and bacterial infection according to treatment with intraventricular alteplase versus saline. Results A total of 279 and 292 patients had ≥3 differential cell counts from serum and CSF, respectively. CSF leukocyte subtypes evolved during IVH resolution with a significantly augmented inflammatory response for all subtypes in alteplase- compared to saline-treated patients. CSF leukocyte subtypes were not associated with detrimental effect on functional outcomes in the full cohort, but all were associated with poor 30-day outcome in saline-treated patients with IVH volume ≥20 mL. Higher serum lymphocytes were associated with good functional outcomes (mRS 0–3) in the entire cohort and saline-treated but not alteplase-treated group. Conversely, increased serum neutrophil-to-lymphocyte ratio (NLR) in the entire cohort and saline group was associated with worse functional outcomes. Higher median serum lymphocytes were associated with the absence of infection at 7 days. Conclusions Aseptic CSF inflammation after IVH involves all leukocyte subtypes. Serum lymphocytes may be associated with better outcomes by mitigating infection. Alteplase augments the inflammatory response without affecting outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02224-w.
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Walsh KB, Zimmerman KD, Zhang X, Demel SL, Luo Y, Langefeld CD, Wohleb E, Schulert G, Woo D, Adeoye O. miR-181a Mediates Inflammatory Gene Expression After Intracerebral Hemorrhage: An Integrated Analysis of miRNA-seq and mRNA-seq in a Swine ICH Model. J Mol Neurosci 2021; 71:1802-1814. [PMID: 33755911 DOI: 10.1007/s12031-021-01815-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/15/2021] [Indexed: 12/22/2022]
Abstract
Intracerebral hemorrhage (ICH) is a severe neurological disorder with no proven treatment. Inflammation after ICH contributes to clinical outcomes, but the relevant molecular mechanisms remain poorly understood. In studies of peripheral leukocyte counts and mRNA-sequencing (mRNA-seq), our group previously reported that monocytes and Interleukin-8 (IL-8) were important contributors to post-ICH inflammation. microRNA (miRNA) are powerful regulators of gene expression and promising therapeutic targets. We now report findings from an integrated analysis of miRNA-seq and mRNA-seq in peripheral blood mononuclear cells (PBMCs) from a swine ICH model. In 10 pigs, one PBMC sample was collected immediately prior to ICH induction and a second 6 h later; miRNA-seq and mRNA-seq were completed for each sample. An aggregate score calculation determined which miRNA regulated the differentially expressed mRNA. Networks of molecular interactions were generated for the combined miRNA/target mRNA. A total of 227 miRNA were identified, and 46 were differentially expressed after ICH (FDR < 0.05). The anti-inflammatory miR-181a was decreased post-ICH, and it was the most highly connected miRNA in the miRNA/mRNA bioinformatic network analysis. miR-181a has interconnected pathophysiology with IL-8 and monocytes; in prior studies, we found that IL-8 and monocytes contributed to post-ICH inflammation and ICH clinical outcome, respectively. miR-181a was a significant mediator of post-ICH inflammation and is promising for further study, including as a potential therapeutic target. This investigation also demonstrated feasible methodology for miRNA-seq/mRNA-seq analysis in swine that is innovative, and with unique challenges, compared with transcriptomics research in more established species.
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Affiliation(s)
- Kyle B Walsh
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, USA.
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Kip D Zimmerman
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Xiang Zhang
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Stacie L Demel
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Yu Luo
- Department of Molecular Genetics, Biochemistry, and Microbiology, University of Cincinnati, Cincinnati, OH, USA
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Eric Wohleb
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, USA
- University of Cincinnati Neurobiology Research Center, Cincinnati, OH, USA
| | - Grant Schulert
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel Woo
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Opeolu Adeoye
- Department of Emergency Medicine, Washington University in St. Louis, St. Louis, MO, USA
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19
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Nguyen D, Tran V, Shirazian A, Velasco-Gonzalez C, Iwuchukwu I. Anti-inflammatory genes in PBMCs post-spontaneous intracerebral hemorrhage. Transl Neurosci 2021; 12:58-66. [PMID: 33564466 PMCID: PMC7844114 DOI: 10.1515/tnsci-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background Neuroinflammation is important in the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and peripheral inflammatory cells play a role in the clinical evolution and outcome. Methodology Blood samples from ICH patients (n = 20) were collected at admission for 5 consecutive days for peripheral blood mononuclear cells (PBMCs). Frozen PBMCs were used for real-time PCR using Taqman probes (NFKB1, SOD1, PPARG, IL10, NFE2L2, and REL) and normalized to GAPDH. Data on hospital length of stay and modified Rankin score (MRS) were collected with 90-day MRS ≤ 3 as favorable outcome. Statistical analysis of clinical characteristics to temporal gene expression from early to delayed timepoints was compared for MRS groups (favorable vs unfavorable) and hematoma volume. Principle findings and results IL10, SOD1, and REL expression were significantly higher at delayed timepoints in PBMCs of ICH patients with favorable outcome. PPARG and REL increased between timepoints in patients with favorable outcome. NFKB1 expression was not sustained, but significantly decreased from higher levels at early onset in patients with unfavorable outcome. IL10 expression showed a negative correlation in patients with high hematoma volume (>30 mL). Conclusions and significance Anti-inflammatory, pro-survival regulators were highly expressed at delayed time points in ICH patients with a favorable outcome, and IL10 expression showed a negative correlation to high hematoma volume.
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Affiliation(s)
- Doan Nguyen
- Institute for Translational Research, Ochsner Medical Center, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America
| | - Vi Tran
- Institute for Translational Research, Ochsner Medical Center, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America
| | - Alireza Shirazian
- Institute for Translational Research, Ochsner Medical Center, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America
| | - Cruz Velasco-Gonzalez
- Center for Outcomes and Health Services Research, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America
| | - Ifeanyi Iwuchukwu
- Institute for Translational Research, Ochsner Medical Center, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America.,Neurocritical Care and Neurology, University of Queensland, Ochsner Clinical School, Ochsner Medical Center, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America.,Neuroscience Center of Excellence, Louisiana State University Health New Orleans, School of Medicine, 2020 Gravier Street, 8th Floor, New Orleans, LA 70112, United States of America.,Department of Neurosurgery, Louisiana State University Health New Orleans, School of Medicine, 2020 Gravier Street, 7th Floor, New Orleans, LA 70112, United States of America
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Bedel C, Korkut M, Selvi F, Zortuk Ö. The Immature Granulocyte Count Is a New Predictor of the 30-Day Mortality in Intracerebral Haemorrhage Patients: Preliminary Study. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0040-1721627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objectives Spontaneous intracerebral hemorrhage (ICH) accounts for 10 to 20% of all types of stroke and is associated with high mortality and morbidity rates. Neuroinflammation caused by intracerebral blood includes resident microglia activation, infiltration of systemic immune cells, and production of cytokines, chemokines, extracellular proteases, and reactive oxygen species. Despite several findings demonstrating that an immature granulocyte (IG) count can be a prognostic indicator as an inflammatory parameter in many diseases, no studies conducted on ICH patients are available in the literature. Therefore, in this study, we aimed to investigate the relationship between the 30-day mortality rate and the IG count obtained at the time of admission in ICH patients.
Methods Demographic characteristics and laboratory test results of patients, who were diagnosed with ICH and hospitalized accordingly upon arrival at the emergency ward in our tertiary care hospital in the period from January 2019 and December 2019, were recorded. The endpoint of the study was the examination of the relationship between the short-term mortality (within 30 days after hospitalization) and the IG count at admission.
Results Seventy patients, who met the inclusion criteria, were included in the study. Of these patients, 40 (57.1%) were males and the mean age was 68.04 ± 13.08 years. Patients with poor prognosis had higher IG counts (p = 0.001). The 30-day mortality rate was 33.3% (11/33) in the high IG count (≥0.6) group and 5.4% (2/37) in the low IG count (< 0.6) group (p = 0.004). In the regression analysis, we found out a significant relationship of the IG count to the 30-day mortality, with an odds ratio of 5.157(95% CI = 0.914–29.087, p = 0.029).
Conclusion An IG count can be obtained from a simple full blood count, is easy to apply, does not result in extra costs, and is used as a marker to predict the 30-day prognosis.
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Affiliation(s)
- Cihan Bedel
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Korkut
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fatih Selvi
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ökkeş Zortuk
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
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Ding YX, Eerduna GW, Duan SJ, Li T, Liu RX, Zhang LM, Wang T, Fu FH. Escin ameliorates the impairments of neurological function and blood brain barrier by inhibiting systemic inflammation in intracerebral hemorrhagic mice. Exp Neurol 2020; 337:113554. [PMID: 33309746 DOI: 10.1016/j.expneurol.2020.113554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/07/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
This study aims to investigate whether escin ameliorates the impairments of neurological function by ameliorating systemic inflammation instead of targeting the brain directly in intracerebral hemorrhage (ICH) mice. It showed that escin did not cross the blood brain barrier (BBB). Compared with the ICH group, the Garcia test scores in the escin groups were significantly increased. Brain water contents and Evans blue extravasation of the right basal ganglia in the ICH group were augmented, and significantly reduced by escin. Escin abated the increases of monocyte counts and serum IL-1β levels induced by ICH. IL-1β administration reversed the effect of escin on Garcia test scores, the brain water contents, and the Evans blue extravasation. Escin ameliorated the increasing levels of RhoA, ROCK1, nuclear NF-κB and the decreasing expression of IκBα, cytosolic NF-κB, occludin, claudin-5 in the ICH group. IL-1β administration blocked not only escin-mediated increases of IκBα, cytosolic NF-κB, occludin, and claudin-5, but also escin-caused decreases of RhoA, ROCK1, and nuclear NF-κB. The results indicate that escin improves neurological outcomes and the BBB function in ICH mice, which is associated with attenuating ICH-induced peripheral system inflammation, and therefore, inhibiting IL-1β/RhoA/NF-κB signaling pathway in BBB, at least in part. These findings suggest that it may be useful to ameliorate brain injury by inhibiting systemic inflammation instead of aiming to target the brain directly after ICH.
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Affiliation(s)
- Yu-Xin Ding
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong 264005, PR China
| | - Gao-Wa Eerduna
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, PR China
| | - Si-Jin Duan
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong 264005, PR China
| | - Ting Li
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong 264005, PR China
| | - Rong-Xia Liu
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong 264005, PR China
| | - Lei-Ming Zhang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong 264005, PR China
| | - Tian Wang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong 264005, PR China.
| | - Feng-Hua Fu
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, Shandong 264005, PR China.
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Systematic Study of the Immune Components after Ischemic Stroke Using CyTOF Techniques. J Immunol Res 2020; 2020:9132410. [PMID: 32908941 PMCID: PMC7474762 DOI: 10.1155/2020/9132410] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 11/17/2022] Open
Abstract
Stroke induces a robust inflammatory response. However, it still lacks a systematic view of the various immune cell types due to the limited numbers of fluorophore used in the traditional FACS technique. In our current study, we utilized the novel technique mass cytometry (CyTOF) to analyze multiple immune cell types. We detected these immune cells from the ischemic brain, peripheral blood, spleen, and bone marrow at different time courses after stroke. Our data showed (1) dynamic changes in the immune cell numbers in the ischemic brain and peripheral organs. (2) The expression levels of cell surface markers indicate the inflammation response status after stroke. Interestingly, CD62L, a key adhesion molecule, regulates the migration of leukocytes from blood vessels into secondary lymphoid tissues and peripheral tissues. (3) A strong leukocyte network across the brain and peripheral immune organs was identified using the R program at day 1 after ischemia, suggesting that the peripheral immune cells dramatically migrated into the ischemic areas after stroke. This study provides a systematic, wide view of the immune components in the brain and peripheral organs for a deep understanding of the immune response after ischemic stroke.
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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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Trifan G, Testai FD. Systemic Immune-Inflammation (SII) index predicts poor outcome after spontaneous supratentorial intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:105057. [PMID: 32807462 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105057] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS In experimental models, enhanced inflammation contributes to secondary brain injury in spontaneous intracerebral hemorrhage (ICH). Several inflammatory markers have investigated in humans with inconclusive results. Here, we report the relationship between Systemic Immune-Inflammation (SII) Index and outcome. METHODS We reviewed the medical records of 239 supratentorial spontaneous ICH patients. Patients were dichotomized based on modified Rankin Scale (mRS) at discharge in good (mRS 0-3) and poor (mRS 4-6) outcome. Demographic, clinical, laboratory and imaging data at admission were compared for both groups. SII index was calculated as [(Platelet counts x Absolute Neutrophil Counts (ANC)/Absolute Lymphocyte Counts (ALC))/1000]. Logistic regression analyses were performed to determine the association between markers of inflammation (ANC, ALC, Platelets, SII index) and outcome adjusting for baseline differences. RESULTS Sixty-two percent of patients had poor outcome (median [IQR] age= 60 [52-71] years). Patients with poor outcome had lower Glasgow coma scale, larger hematoma volumes, and higher incidence of diabetes and intraventricular extension (p<0.05 for each variable). In univariate analysis, ANC and SII index were independently associated with poor outcome (p<0.05). In multivariate analysis, only SII index remained significantly associated with poor outcome (OR=1.34, 95% CI=1.04-1.72, p=0.02). ROC analysis showed that adjusted SII index is a good discriminator for poor outcome (AUC=0.89, 95% CI=0.84-0.93; P <0.0001), with the best cut-off value being 0.73 (Sensitivity 95%, Specificity 71%). CONCLUSIONS In patients with supratentorial spontaneous ICH early SII index is an independent predictor of poor outcome at time of hospital discharge.
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Affiliation(s)
- Gabriela Trifan
- Department of Neurology and Rehabilitation, Chicago College of Medicine, University of Illinois, United States.
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, Chicago College of Medicine, University of Illinois, United States.
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Jiang C, Wang Y, Hu Q, Shou J, Zhu L, Tian N, Sun L, Luo H, Zuo F, Li F, Wang Y, Zhang J, Wang J, Wang J, Zhang J. Immune changes in peripheral blood and hematoma of patients with intracerebral hemorrhage. FASEB J 2020; 34:2774-2791. [PMID: 31912591 DOI: 10.1096/fj.201902478r] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/27/2019] [Accepted: 12/09/2019] [Indexed: 01/22/2023]
Abstract
Immunologic changes in the hematoma of patients with intracerebral hemorrhage (ICH) and the contribution of these changes to prognosis are unknown. We collected the blood samples and hematoma fluid from 35 patients with acute ICH (<30 hours from symptom onset) and 55 age-matched healthy controls. Using flow cytometry and ELISA, we found that the percentages of granulocytes, regulatory T cells, helper T (Th) 17 cells, and dendritic cells were higher in the peripheral blood of patients with ICH than in healthy controls, whereas the percentages of lymphocytes, M1-like macrophages, and M2-like macrophages were lower. Levels of IL-6, IL-17, IL-23, TNF-α, IL-4, IL-10, and TGF-β were higher in the peripheral blood of patients with ICH. The absolute counts of white blood cells, lymphocytes, monocytes, and granulocytes in the hematoma tended to be greater at 12-30 hours than they were within 12 hours after ICH, but the percentage of Th cells decreased in peripheral blood. Increased levels of IL-10 in the serum and hematoma, and a reduction in M1-like macrophages in hematoma were independently associated with favorable outcome on day 90. These results indicate that immunocytes present in the hematoma may participate in the acute-phase inflammatory response after ICH.
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Affiliation(s)
- Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Yali Wang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Qiangfu Hu
- Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Jixin Shou
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Li Zhu
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Ning Tian
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Lu Sun
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Huan Luo
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Fangfang Zuo
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Fangfang Li
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Yingying Wang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Jing Zhang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Henan, P.R. China
| | - Jiarui Wang
- Winston Churchill High School, Potomac, Maryland
| | - Jian Wang
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Jiewen Zhang
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, P.R. China
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He W, Ruan Y, Yuan C, Cheng Q, Cheng H, Zeng Y, Chen Y, Huang G, Chen H, He J. High Neutrophil-to-Platelet Ratio Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke. Front Neurol 2019; 10:1310. [PMID: 31920933 PMCID: PMC6914868 DOI: 10.3389/fneur.2019.01310] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Hemorrhagic transformation (HT) is a complication that may cause neurological deterioration in patients with acute ischemic stroke. Both neutrophil and platelet have been associated with the stroke progression. The aim of this study was to explore the relationship between neutrophil-to-platelet ratio (NPR) and HT after acute ischemic stroke. Methods: A total of 279 stroke patients with HT were consecutively recruited. HT was diagnosed using magnetic resonance imaging (MRI) or computed tomography (CT) and classified into hemorrhagic infarction (HI) and parenchymal hematoma (PH). Blood samples for neutrophil and platelet counts were obtained at admission. Meanwhile, 270 age- and gender-matched controls without HT were included for comparison. Results: Among the patients with HT, 131 patients had PH and 148 patients had HI. NPR was higher in patients with PH than those with HI or non-HT [36.8 (23.7–49.2) vs. 26.6 (17.9–38.3) vs. 19.1 (14.8–24.8), P < 0.001]. After adjustment for potential confounders, high NPR remained independently associated with the increased risk of HT (OR = 2.000, 95% CI: 1.041–3.843, P = 0.037). NPR (>39.9) was independently associated with PH (OR = 2.641, 95% CI: 1.308–5.342, P = 0.007). Conclusions: High NPR was associated with the increased risk of HT especially PH in patients with acute ischemic stroke.
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Affiliation(s)
- Weilei He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiting Ruan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengxiang Yuan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qianqian Cheng
- Department of Mental Health, Mental Health School, Wenzhou Medical University, Wenzhou, China
| | - Haoran Cheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yaying Zeng
- Department of Mental Health, Mental Health School, Wenzhou Medical University, Wenzhou, China
| | - Yunbin Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huijun Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Dong X, Nao J, Shi J, Zheng D. Predictive Value of Routine Peripheral Blood Biomarkers in Alzheimer's Disease. Front Aging Neurosci 2019; 11:332. [PMID: 31866854 PMCID: PMC6906180 DOI: 10.3389/fnagi.2019.00332] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background Biomarker screening is of major significance for the early diagnosis and prevention of Alzheimer’s disease (AD). Routine peripheral blood parameters are easy to collect and detect, making them ideal potential biomarkers. Thus, we aimed to evaluate the parameters from routine blood as potential biomarkers for AD. Methods We enrolled 56 AD patients, 57 mild cognitive impairment (MCI) patients, and 59 healthy elderly controls. Receiver operating characteristic (ROC) curves were used to assess the diagnostic values of routine blood biomarkers in patients with cognitive impairment. Results There were significant differences in eight parameters between the groups. Logistic regression revealed that the neutrophil% (odds ratio (OR) 1.34, 95% confidence interval [CI] 1.03–1.75, p = 0.031) and neutrophil-to-lymphocyte ratio (NLR; OR 6.27, 95% CI 3.98–9.82, p = 0.003) differentiated AD patients and controls (areas under the curve [AUCs], 0.728 and 0.721) and that the NLR (OR 1.93, 95% CI 1.07–3.47, p = 0.028) and mean platelet volume (OR 1.67, 95% CI 1.04–2.70, p = 0.036) differentiated MCI patients and controls (AUCs, 0.60 and 0.638). There were no effective diagnostic biomarkers to distinguish AD from MCI. Conclusion Some routine blood biomarkers may correlate with cognitive impairment. Analysis of these biomarkers, such as the NLR, may be useful for the identification of patients with cognitive impairment.
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Affiliation(s)
- Xiaoyu Dong
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianfei Nao
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jile Shi
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dongming Zheng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
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Chen Q, Liu J, Xu H, He W, Li Y, Jiao L, Xiang Y, Zhan C, Chen J, Yang X, Huang S, Yang Y. Association Between Eosinophilic Leukocyte Count and Hematoma Expansion in Acute Spontaneous Intracerebral Hemorrhage. Front Neurol 2019; 10:1164. [PMID: 31736868 PMCID: PMC6834787 DOI: 10.3389/fneur.2019.01164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/15/2019] [Indexed: 01/21/2023] Open
Abstract
Background/Objective: Hematoma expansion (HE) predicts poor outcome and is an appealing treatment target in spontaneous intracerebral hemorrhage (ICH). Clinical evidence has shown an association of HE with peripheral white blood cells (WBC) count, but the individual contributions of leukocyte subtypes between literatures are described inconsistently. Our aim was to determine the relationship between admission absolute and differential leukocyte counts and HE by using different growth definitions. Methods: We analyzed spontaneous ICH patients who underwent baseline cranial computed tomography and blood sampling within 6 h of stroke onset in our institution between September 2013 and August 2018. Hematoma volume was calculated using a semiautomated 3-dimensional reconstruction algorithm. According to commonly used absolute or relative growth definitions (>6 mL, >12.5 mL, or >33%), we defined 5 types of HE. A propensity score-matching analysis was performed to evaluate the influence of complete blood count components on HE across the various growth definitions. The receiver operating characteristic analysis assessed the predictive ability of leukocyte counts for HE. Results: A total of 1,066 patients were included, of whom 11–21% met the 5 HE definitions. After propensity score-matching, except using the definition of >12.5 mL growth or its combination with >33% growth, both WBC and neutrophil count were independently associated with reduced risk of HE (odds ratio [OR] for 103 cells increase; OR, 0.86–0.99; all p < 0.05) after adjusting confounders in multivariate analyses. However, monocyte count was correlated with increased risk of HE under the usage of >12.5 mL expansion definition only (OR, 1.43; p = 0.024). There was no association between lymphocyte count and HE (all p > 0.05). Regardless of the growth definition, admission eosinophil count was directly associated with the risk of HE (OR, 6.92–31.60; all p < 0.05), and was the best predictive subtype with area under the curve 0.64, sensitivity 69.5%, and specificity 58.9% at the optimal cut-off value of 45 cells/μL. Conclusions: Growth definition affects the relationship of HE with leukocyte subtypes counting. Eosinophil count robustly predicts HE, and may be a surrogate when using an inflammatory marker to help select acute ICH patients with high expansion risk for hemostasis treatment in clinical trial and practice.
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Affiliation(s)
- Qian Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haoli Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenwen He
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanxuan Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lizhuo Jiao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yilan Xiang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenyi Zhan
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengwei Huang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Stamova B, Ander BP, Jickling G, Hamade F, Durocher M, Zhan X, Liu DZ, Cheng X, Hull H, Yee A, Ng K, Shroff N, Sharp FR. The intracerebral hemorrhage blood transcriptome in humans differs from the ischemic stroke and vascular risk factor control blood transcriptomes. J Cereb Blood Flow Metab 2019; 39:1818-1835. [PMID: 29651892 PMCID: PMC6727143 DOI: 10.1177/0271678x18769513] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Understanding how the blood transcriptome of human intracerebral hemorrhage (ICH) differs from ischemic stroke (IS) and matched controls (CTRL) will improve understanding of immune and coagulation pathways in both disorders. This study examined RNA from 99 human whole-blood samples using GeneChip® HTA 2.0 arrays to assess differentially expressed transcripts of alternatively spliced genes between ICH, IS and CTRL. We used a mixed regression model with FDR-corrected p(Dx) < 0.2 and p < 0.005 and |FC| > 1.2 for individual comparisons. For time-dependent analyses, subjects were divided into four time-points: 0(CTRL), <24 h, 24-48 h, >48 h; 489 transcripts were differentially expressed between ICH and CTRL, and 63 between IS and CTRL. ICH had differentially expressed T-cell receptor and CD36 genes, and iNOS, TLR, macrophage, and T-helper pathways. IS had more non-coding RNA. ICH and IS both had angiogenesis, CTLA4 in T lymphocytes, CD28 in T helper cells, NFAT regulation of immune response, and glucocorticoid receptor signaling pathways. Self-organizing maps revealed 4357 transcripts changing expression over time in ICH, and 1136 in IS. Understanding ICH and IS transcriptomes will be useful for biomarker development, treatment and prevention strategies, and for evaluating how well animal models recapitulate human ICH and IS.
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Affiliation(s)
- Boryana Stamova
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Bradley P Ander
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Glen Jickling
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA.,2 Department of Medicine, University of Alberta, Edmonton, Canada
| | - Farah Hamade
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Marc Durocher
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Xinhua Zhan
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Da Zhi Liu
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Xiyuan Cheng
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Heather Hull
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Alan Yee
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Kwan Ng
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Natasha Shroff
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Frank R Sharp
- 1 Department of Neurology, School of Medicine, University of California at Davis, Sacramento, CA, USA
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Walsh KB, Zhang X, Zhu X, Wohleb E, Woo D, Lu L, Adeoye O. Intracerebral Hemorrhage Induces Inflammatory Gene Expression in Peripheral Blood: Global Transcriptional Profiling in Intracerebral Hemorrhage Patients. DNA Cell Biol 2019; 38:660-669. [PMID: 31120332 PMCID: PMC6909779 DOI: 10.1089/dna.2018.4550] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/03/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
To perform global transcriptome profiling using RNA-seq in the peripheral blood of intracerebral hemorrhage (ICH) patients. In 11 patients with ICH, peripheral blood was collected within 24 h of symptom onset or last known well, and a second blood draw occurred 72 h (±6) after the first. RNA-seq identified differentially expressed genes (DEGs) between the first and second samples. Biological pathway enrichment analysis was performed with Ingenuity® Pathway Analysis (IPA). A total of 16,640 genes were identified and 218 were significant DEGs after ICH (false discovery rate <0.1). IPA identified 97 disease and functional categories that were significantly upregulated (z-score >2) post-ICH; 46 categories were specifically related to immune cell activation, 22 to general cellular activation processes, and 4 to other inflammation-related responses. In the canonical pathway and network analysis, inflammatory mediators of particular importance included interleukin-8, NF-κB, ERK1/2, and members of the integrin class. ICH induced peripheral blood gene expression at 72 to 96 h compared with 0 to 24 h from symptom onset. DEGs that were highly expressed included those related to inflammation and activation of the immune response. Further research is needed to determine whether these changes affect outcomes and may represent new therapeutic targets.
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Affiliation(s)
- Kyle B. Walsh
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Xiang Zhang
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Xiaoting Zhu
- Division of Biomedical Informatics, Cincinnati Children's Research Foundation, Cincinnati, Ohio
| | - Eric Wohleb
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, Ohio
- University of Cincinnati Neurobiology Research Center, Cincinnati, Ohio
| | - Daniel Woo
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Long Lu
- Division of Biomedical Informatics, Cincinnati Children's Research Foundation, Cincinnati, Ohio
| | - Opeolu Adeoye
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
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Under-recognized post-stroke acute kidney injury: risk factors and relevance for stroke outcome of a frequent comorbidity. Int Urol Nephrol 2019; 51:1597-1604. [PMID: 31250340 DOI: 10.1007/s11255-019-02203-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is emerging as a predictor of poor stroke outcome, however, it is often not recognized. The aim of our study was to evaluate post-stroke AKI burden, AKI risk factors and their influence in post-stroke outcome. METHODS From 2013 to 2016, 440 individuals with stroke diagnosis admitted in Stroke Unit, Foundation IRCCS Policlinico San Matteo (Pavia, Italy), were retrospectively enrolled. AKI cases identified by KDIGO criteria through the electronic database and hospital chart review were compared with the ones reported in discharge letters or in administrative hospital data base. Mortality data were provided by Agenzia Tutela della Salute of Pavia. RESULTS We included 430 patients in the analysis. Median follow-up was 19.2 months. We identified 79 AKI cases (18% of the enrolled patients, 92% classified as AKI stage 1), a fivefold higher number of cases than the ones reported at discharge. 37 patients had AKI at the admission in the hospital, while 42 developed AKI during the hospitalization. Cardioembolic (p = 0.01) and hemorrhagic (p = 0.01) stroke types were associated with higher AKI risk. Admission National Institutes of Health Stroke Scale (NIHSS, p < 0.05) and Charlson Comorbidity Index (p < 0.01) were independently associated with overall AKI, while admission NIHSS (p < 0.05) and eGFR (p < 0.005) were independently associated with AKI developed during the hospitalization. AKI was associated to longer in-hospital stay (p = 0.01), worse Rankin Neurologic Disability Score at discharge (p < 0.0001) and discharge disposition other than home (p = 0.03). AKI was also independently associated to higher in-hospital mortality (OR 3.9 95% CI 1.2-12.9 p = 0.023) but not with long-term survival. CONCLUSIONS Post-stroke AKI diagnosis needs to be improved by strictly monitoring individuals with cardioembolic or hemorrhagic stroke, reduced kidney function, higher Charlson Comorbidity Index and worse NIHSS at presentation.
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Walsh KB, Zhang X, Zhu X, Wohleb E, Woo D, Lu L, Adeoye O. Intracerebral hemorrhage induces monocyte-related gene expression within six hours: Global transcriptional profiling in swine ICH. Metab Brain Dis 2019; 34:763-774. [PMID: 30796715 PMCID: PMC6910870 DOI: 10.1007/s11011-019-00399-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/13/2019] [Indexed: 12/12/2022]
Abstract
Intracerebral hemorrhage (ICH) is a severe neurological disorder with no proven treatment. Our prior research identified a significant association with monocyte level and ICH mortality. To advance our understanding, we sought to identify gene expression after ICH using a swine model to test the hypothesis that ICH would induce peripheral blood mononuclear cell (PBMC) gene expression. In 10 pigs with ICH, two PBMC samples were drawn from each with the first immediately prior to ICH induction and the second six hours later. RNA-seq was performed with subsequent bioinformatics analysis using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Ingenuity® Pathway Analysis (IPA). There were 182 significantly upregulated and 153 significantly down-regulated differentially expressed genes (DEGs) after ICH. Consistent with findings in humans, significant GO and KEGG pathways were primarily related to inflammation and the immune response. Five genes, all upregulated post-ICH and known to be associated with monocyte activation, were repeatedly DEGs in the significant KEGG pathways: CD14, TLR4, CXCL8, IL-18, and CXCL2. In IPA, the majority of upregulated disease/function categories were related to inflammation and immune cell activation. TNF and LPS were the most significantly activated upstream regulators, and ERK was the most highly connected node in the top network. ICH induced changes in PBMC gene expression within 6 h of onset related to inflammation, the immune response, and, more specifically, monocyte activation. Further research is needed to determine if these changes affect outcomes and may represent new therapeutic targets.
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Affiliation(s)
- Kyle B Walsh
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, USA.
- Department of Emergency Medicine, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0769, USA.
| | - Xiang Zhang
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Xiaoting Zhu
- Division of Biomedical Informatics, Cincinnati Children's Research Foundation, Cincinnati, OH, USA
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Eric Wohleb
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, USA
- University of Cincinnati Neurobiology Research Center, Cincinnati, OH, USA
| | - Daniel Woo
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Long Lu
- Division of Biomedical Informatics, Cincinnati Children's Research Foundation, Cincinnati, OH, USA
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Opeolu Adeoye
- University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, USA
- Department of Emergency Medicine, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0769, USA
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Wang Y, Jin H, Wang W, Wang F, Zhao H. Myosin1f-mediated neutrophil migration contributes to acute neuroinflammation and brain injury after stroke in mice. J Neuroinflammation 2019; 16:77. [PMID: 30971272 PMCID: PMC6456973 DOI: 10.1186/s12974-019-1465-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/26/2019] [Indexed: 01/06/2023] Open
Abstract
Background During the acute stroke phase, neutrophils from the peripheral blood are first to arrive in the ischemic brain, which then attracts other immune cells that exacerbate neuroinflammation in the ischemic tissue. Myosin1f was reported to specifically mediate neutrophil migration in the peripheral tissues, but whether it plays a critical role in the neuroinflammatory response after ischemic stroke remains unknown. In this study, we aim to test the hypothesis that myosin1f-mediated neutrophil migration is critical in acute neuroinflammation induced by ischemic stroke. Methods Myosin1f −/− and wild type (WT) mice were subjected to transient middle cerebral artery occlusion (MCAO). To determine which cells determine myosin1f’s transmigration ability, bone marrow transplantation, neutrophil depletion, and adoptive neutrophil transfer were performed. The myosin1f RNA level was assessed in peripheral neutrophils by reverse transcription polymerase chain reaction (RT-PCR) at 1 day and 3 days after stroke. The infiltrating neutrophils were quantified by immunofluorescence staining and FACS at 72 h after reperfusion. Results The myosin1f −/− mice had significantly smaller infarctions than the myosin1f +/+ mice. Bone marrow transplantation from myosin1f −/− mice to recipient mice also had smaller infarctions compared to animals receiving bone marrow from myosin1f +/+ mice. By performing neutrophil depletion and adoptive transfer, we confirmed that myosin1f acts mainly in circulating neutrophils. RT-PCR showed that myosin1f gene expression was increased in the circulating blood neutrophils at 3 days after ischemia. The confocal immunostaining and FACS results confirmed that fewer neutrophils infiltrated into the ischemic brain in myosin1f −/− mice compared to WT mice. Conclusions Myosin1f determines neutrophil migration into the ischemic hemisphere, which directly affects stroke outcome. Electronic supplementary material The online version of this article (10.1186/s12974-019-1465-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yan Wang
- Department of Neurosurgery, Stanford University School of Medicine, 1201 Welch Road, MSLS Building, Room P306, Stanford, CA, 94305, USA
| | - Haojie Jin
- Department of Plant Biology, Carnegie Institution for Science, Stanford, CA, 94305, USA
| | - Weifang Wang
- Center for Microbiota and Immunological Diseases, Shanghai General Hospital, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Building 5#, Room 807#, Shanghai, 200025, China
| | - Feng Wang
- Center for Microbiota and Immunological Diseases, Shanghai General Hospital, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, 280 South Chongqing Road, Building 5#, Room 807#, Shanghai, 200025, China.
| | - Heng Zhao
- Department of Neurosurgery, Stanford University School of Medicine, 1201 Welch Road, MSLS Building, Room P306, Stanford, CA, 94305, USA.
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Zhu H, Wang Z, Yu J, Yang X, He F, Liu Z, Che F, Chen X, Ren H, Hong M, Wang J. Role and mechanisms of cytokines in the secondary brain injury after intracerebral hemorrhage. Prog Neurobiol 2019; 178:101610. [PMID: 30923023 DOI: 10.1016/j.pneurobio.2019.03.003] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/07/2019] [Accepted: 03/16/2019] [Indexed: 12/18/2022]
Abstract
Intracerebral hemorrhage (ICH) is a common and severe cerebrovascular disease that has high mortality. Few survivors achieve self-care. Currently, patients receive only symptomatic treatment for ICH and benefit poorly from this regimen. Inflammatory cytokines are important participants in secondary injury after ICH. Increases in proinflammatory cytokines may aggravate the tissue injury, whereas increases in anti-inflammatory cytokines might be protective in the ICH brain. Inflammatory cytokines have been studied as therapeutic targets in a variety of acute and chronic brain diseases; however, studies on ICH are limited. This review summarizes the roles and functions of various pro- and anti-inflammatory cytokines in secondary brain injury after ICH and discusses pathogenic mechanisms and emerging therapeutic strategies and directions for treatment of ICH.
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Affiliation(s)
- Huimin Zhu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China
| | - Zhiqiang Wang
- Central laboratory, Linyi People's Hospital, Linyi, Shandong 276003, China
| | - Jixu Yu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China; Central laboratory, Linyi People's Hospital, Linyi, Shandong 276003, China; Genetics and Aging Research Unit, Department of Neurology, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Xiuli Yang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Feng He
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China
| | - Zhenchuan Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China.
| | - Fengyuan Che
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China; Central laboratory, Linyi People's Hospital, Linyi, Shandong 276003, China.
| | - Xuemei Chen
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Honglei Ren
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Michael Hong
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jian Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Zhang F, Ren Y, Fu W, Yang Z, Wen D, Hu X, Tao C, Li X, You C, Xin T, Yang M. Predictive Accuracy of Neutrophil-to-Lymphocyte Ratio on Long-Term Outcome in Patients with Spontaneous Intracerebral Hemorrhage. World Neurosurg 2019; 125:e651-e657. [PMID: 30716500 DOI: 10.1016/j.wneu.2019.01.143] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is well established that inflammation plays a critical role in the progression of intracerebral hemorrhage (ICH). Recently the neutrophil-to-lymphocyte ratio (NLR) was identified as a predictor for the short-term outcome in ICH patients. However, the association of NLR with the long-term outcome in patients with ICH remains unknown. Here, we aimed to assess the relationship between NLR and the long-term prognosis in ICH patients. METHODS All patients with spontaneous ICH who were hospitalized at West China Hospital of Sichuan University from October 2013 to May 2017 were retrospectively enrolled. White blood count, absolute count of neutrophils, and lymphocytes were extracted from electronic medical records, and NLR was calculated according to admission neutrophil count (ANC) and lymphocyte count (ALC). The associations between long-term outcomes and laboratory biomarkers were estimated by multivariable logistic regression analysis. Receiver operating characteristic (ROC) curves were also determined to compare the predictive powers between each inflammatory factor. RESULTS A total of 481 ICH patients were included in the study. Of those, 204 presented with unfavorable outcomes, and 142 were dead within 6 months. Age, Glasgow Coma Scale (GCS) scores, WBC, ANC, NLR, hematoma size, and hydrocephalus were independently associated with poor prognosis of ICH. Multiple linear analysis showed GCS, hematoma volume, WBC, ANC, and ALC to be correlated with NLR. Moreover, in comparison with other single laboratory determinations, NLR also showed better predictive capacity for long-term mortality and morbidity, for which the best predictive cutoff values were 9.07 and 8.69, respectively. CONCLUSIONS NLR independently predicts 180-day morbidity and 180-day mortality in patients with spontaneous ICH.
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Affiliation(s)
- Fan Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; Department of Pathology, Case Western Reserve University, Ohio, Cleveland, USA
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Fu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zijia Yang
- Department of Neurosurgery, Chengdu First People's Hospital, Chengdu, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Xin
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Mu Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; Department of Neurosurgery, Chengdu First People's Hospital, Chengdu, China; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada; Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.
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Napier J, Rose L, Adeoye O, Hooker E, Walsh KB. Modulating acute neuroinflammation in intracerebral hemorrhage: the potential promise of currently approved medications for multiple sclerosis. Immunopharmacol Immunotoxicol 2019; 41:7-15. [PMID: 30702002 DOI: 10.1080/08923973.2019.1566361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The secondary inflammatory injury following intracerebral hemorrhage (ICH) results in increased morbidity and mortality. White blood cells have been implicated as critical mediators of this inflammatory injury. Currently, no medications have been clinically proven to ameliorate or beneficially modulate inflammation, or to improve outcomes by any mechanism, following ICH. However, other neuroinflammatory conditions, such as multiple sclerosis, have approved pharmacologic therapies that modulate the inflammatory response and minimize the damage caused by inflammatory cells. Thus, there is substantial interest in existing therapies for neuroinflammation and their potential applicability to other acute neurological diseases such as ICH. In this review, we examined the mechanism of action of twelve currently approved medications for multiple sclerosis: alemtuzumab, daclizumab, dimethyl fumarate, fingolimod, glatiramer acetate, interferon beta-1a, interferon beta-1b, mitoxantrone, natalizumab, ocrelizumab, rituximab, teriflunomide. We analyzed the existing literature pertaining to the effects of these medications on various leukocytes and also with emphasis on mechanisms of action during the acute period following initiation of therapy. As a result, we provide a valuable summary of the current body of knowledge regarding these therapies and evidence that supports or refutes their likely promise for treating neuroinflammation following ICH.
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Affiliation(s)
- Jarred Napier
- a College of Medicine , University of Cincinnati , Cincinnati , OH , USA
| | - Lucas Rose
- a College of Medicine , University of Cincinnati , Cincinnati , OH , USA
| | - Opeolu Adeoye
- b Department of Emergency Medicine , University of Cincinnati , Cincinnati , OH , USA.,c Gardner Neuroscience Institute , University of Cincinnati , Cincinnati , OH , USA
| | - Edmond Hooker
- b Department of Emergency Medicine , University of Cincinnati , Cincinnati , OH , USA
| | - Kyle B Walsh
- b Department of Emergency Medicine , University of Cincinnati , Cincinnati , OH , USA.,c Gardner Neuroscience Institute , University of Cincinnati , Cincinnati , OH , USA
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Qi H, Wang D, Deng X, Pang X. Lymphocyte-to-Monocyte Ratio Is an Independent Predictor for Neurological Deterioration and 90-Day Mortality in Spontaneous Intracerebral Hemorrhage. Med Sci Monit 2018; 24:9282-9291. [PMID: 30572340 PMCID: PMC6320655 DOI: 10.12659/msm.911645] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Lymphocyte-to-monocyte ratio (LMR) is an independent predictive factor of clinical outcome of acute ischemic stroke and cancer, but the predictive effect of LMR in spontaneous intracerebral hemorrhage (ICH) is unknown. Thus, the aim of this study was to explore the impact of peripheral LMR on the neurological deterioration (ND) during the initial week after spontaneous ICH onset, as well as 90-day mortality. MATERIAL AND METHODS The clinical data of 558 consecutive patients with ICH were retrospectively analyzed. LMR is calculated by absolute lymphocyte count divided by absolute monocyte count. RESULTS Of these patients, 166 patients experienced ND during the first week after admission and 72 patients died within 90 days. Multivariate analysis indicated that white blood cells (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio (NLR), LMR were significantly associated with ND during the initial week after ICH onset and also were associated with 90-day mortality. Moreover, NLR and LMR showed a higher predictive ability in ND during the initial week after ICH onset than 90-day mortality in receiver operating characteristic analysis. The best cut-off points of NLR and LMR in predicting ND and 90-day mortality were 10.24 and 2.21 and 16.81 and 2.19, respectively. CONCLUSIONS Our results suggest that LMR on admission is a predictive factor for ND during the initial week after ICH onset, as well as 90-day mortality.
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Affiliation(s)
- Haijun Qi
- Department of Neurosurgery, Ulanqab Central Hospital, Ulanqab, Inner Mongolia, China (mainland)
| | - Dong Wang
- Department of Neurology, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia, China (mainland)
| | - Xiuling Deng
- College of Basic Medicine, Inner Mongolia Medical University, Hohhot, Inner Monglia, China (mainland)
| | - Xuefei Pang
- Department of Medical Engineering, Ulanqab Central Hospital, Ulanqab, Inner Mongolia, China (mainland)
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Landreneau MJ, Mullen MT, Messé SR, Cucchiara B, Sheth KN, McCullough LD, Kasner SE, Sansing LH. CCL2 and CXCL10 are associated with poor outcome after intracerebral hemorrhage. Ann Clin Transl Neurol 2018; 5:962-970. [PMID: 30128320 PMCID: PMC6093844 DOI: 10.1002/acn3.595] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Intracerebral hemorrhage carries a high mortality and survivors are frequently left with significant disability. Immunological mechanisms may play an important role in hemorrhage-induced brain injury, however, research linking these mechanisms with clinical outcome remains limited. We aim to identify serum inflammatory mediators that are associated with outcome after intracerebral hemorrhage in order to translate data from experimental models to a patient cohort and identify potential targets worthy of reverse translation. METHODS A prospective cohort study at two comprehensive stroke centers enrolled patients with spontaneous intracerebral hemorrhage. Peripheral blood was collected at 6, 24, and 72 h from onset. Functional outcome was assessed at 90 days using the modified Rankin Scale (mRS). Serum inflammatory mediators were measured using multiplex ELISA. Multivariable modeling identified serum biomarkers independently associated with functional outcome at 90 days. RESULTS 115 patients completed the study. At 6 h after onset, patients with elevated CCL2 had worse mRS score at day 90 (OR 4.07, 95% CI 1.27-13.10, P = 0.02) after adjusting for age, gender, ICH volume, IVH, infratentorial location and NIHSS score. At 24 and 72 h after onset, elevation in CXCL10 was independently associated with worse 90 days mRS score (24 h: OR 8.08, 95% CI 2.69-24.30, P < 0.001; 72 h: OR 3.89, 95% CI 1.12-13.49, P = 0.03). INTERPRETATION Acute and subacute elevations in specific immune factors are associated with poor outcome, highlighting potential pathways that may contribute to ongoing brain injury in patients with intracerebral hemorrhage.
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Affiliation(s)
| | - Michael T. Mullen
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Steven R. Messé
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Brett Cucchiara
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Kevin N. Sheth
- Department of NeurologyYale University School of MedicineNew HavenConnecticut
- Center for Neuroepidemiology and Clinical Neurological ResearchYale School of MedicineNew HavenConnecticut
| | - Louise D. McCullough
- Department of NeurologyUniversity of Texas Health Sciences Center at HoustonHoustonTexas
| | - Scott E. Kasner
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Lauren H. Sansing
- Department of NeurologyYale University School of MedicineNew HavenConnecticut
- Center for Neuroepidemiology and Clinical Neurological ResearchYale School of MedicineNew HavenConnecticut
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Wang F, Xu F, Quan Y, Wang L, Xia JJ, Jiang TT, Shen LJ, Kang WH, Ding Y, Mei LX, Ju XF, Hu SY, Wu X. Early increase of neutrophil-to-lymphocyte ratio predicts 30-day mortality in patients with spontaneous intracerebral hemorrhage. CNS Neurosci Ther 2018; 25:30-35. [PMID: 29767470 PMCID: PMC6436579 DOI: 10.1111/cns.12977] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 12/31/2022] Open
Abstract
Aims To examine whether early rise of neutrophil‐to‐lymphocyte ratio (NLR) after patient hospitalization correlates with 30‐day mortality in patients with spontaneous intracerebral hemorrhage (ICH). Methods This retrospective study included all patients receiving treatment for spontaneous ICH between January 2015 and September 2016 at the Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences in Shanghai, China. NLR was determined at admission (T1), at 24‐48 hours (T2) and 5‐7 days (T3). NLR and clinicopathologic features were compared between those who survived for >30 days vs not. Multivariate regression was used to identify risk factors for 30‐day mortality. Results A total of 275 subjects were included in the analysis: 235 survived for at least 30 days; the remaining 40 subjects died within 30 days. The patients who died within 30 days had higher ICH score, larger ICH volume, and lower GCS score (all P < 0.05). In comparison with the baseline (NLRT1), NLR at 24‐48 hours (NLRT2) and 5‐7 days (NLRT3) was significantly higher in patients who died within 30 days (P < 0.05), but not in patients surviving for >30 days. In the multivariate analysis, the 30‐day mortality was associated with both NLRT2 (OR 1.112, 95%CI 1.032‐1.199, P = 0.006) and NLRT3 (OR 1.163, 95%CI 1.067‐1.268, P = 0.001). Spearman correlation analysis showed that both NLRT2 and NLRT3 correlated inversely with GCS score and positively with ICH score and ICH volume at the baseline. Conclusions Early rise of NLR predicts 30‐day mortality in patients with spontaneous ICH.
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Affiliation(s)
- Fei Wang
- Department of Critical Care Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Feng Xu
- Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ye Quan
- Juyuan New District Community Healthcare Center of Jiading District, Shanghai, China
| | - Li Wang
- Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jian-Jun Xia
- Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ting-Ting Jiang
- Department of Critical Care Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Li-Juan Shen
- Department of Clinical Laboratory, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Wen-Hui Kang
- Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yong Ding
- Jiading Town Community Healthcare Center of Jiading District, Shanghai, China
| | - Li-Xia Mei
- Jiading Town Community Healthcare Center of Jiading District, Shanghai, China
| | - Xue-Feng Ju
- Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Shan-You Hu
- Department of Critical Care Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Xiao Wu
- Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
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Xu C, Ge H, Wang T, Qin J, Liu D, Liu Y. Increased Expression of T Cell Immunoglobulin and Mucin Domain 3 on CD14 + Monocytes Is Associated with Systemic Inflammatory Reaction and Brain Injury in Patients with Spontaneous Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:1226-1236. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022] Open
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Abstract
BACKGROUND To identify the patients at greatest odds for systemic inflammatory response syndrome (SIRS) and examine the association between SIRS and outcomes in patients presenting with intracerebral hemorrhage (ICH). METHODS We retrospectively reviewed consecutive patients presenting to a tertiary care center from 2008 to 2013 with ICH. SIRS was defined according to standard criteria as 2 or more of the following: (1) body temperature <36 or >38 °C, (2) heart rate >90 beats per minute, (3) respiratory rate >20, or (4) white blood cell count <4000/mm(3) or >12,000/mm(3) or >10 % polymorphonuclear leukocytes for >24 h in the absence of infection. The outcomes of interest, discharge modified Rankin Scale (mRS 4-6), death, and poor discharge disposition (discharge anywhere but home or inpatient rehab) were assessed using logistic regression. RESULTS A total of 249 ICH patients met inclusion criteria and 53 (21.3 %) developed SIRS during their hospital stay. A score was developed (ranging from 0 to 3) to identify patients at greatest risk for developing SIRS. Adjusting for stroke severity, SIRS was associated with mRS 4-6 (OR 5.25, 95 %CI 2.09-13.2) and poor discharge disposition (OR 3.74, 95 %CI 1.58-4.83) but was not significantly associated with death (OR 1.75, 95 %CI 0.58-5.32). We found that 33 % of the effect of ICH score on poor functional outcome at discharge was explained by the development of SIRS in the hospital (Sobel 2.11, p = 0.03). CONCLUSION We observed that approximately 20 % of patients with ICH develop SIRS, and that patients with SIRS were at increased risk of having poor functional outcome at discharge.
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James ML, Christianson T, Woo D, Kon NKK. Gonadal hormone regulation as therapeutic strategy after acute intracerebral hemorrhage. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817725081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Daniel Woo
- Department of Neurology, University of Cincinnati, USA
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M2 Monocyte Microparticles Are Increased in Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2017; 26:2369-2375. [PMID: 28606659 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/17/2017] [Indexed: 12/13/2022] Open
Abstract
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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O’Connell GC, Petrone AB, Tennant CS, Lucke-Wold N, Kabbani Y, Tarabishy AR, Chantler PD, Barr TL. Circulating extracellular DNA levels are acutely elevated in ischaemic stroke and associated with innate immune system activation. Brain Inj 2017; 31:1369-1375. [PMID: 28585898 DOI: 10.1080/02699052.2017.1312018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Grant C. O’Connell
- Center for Basic and Translational Stroke Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
- Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Ashley B. Petrone
- Center for Basic and Translational Stroke Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Connie S. Tennant
- Center for Basic and Translational Stroke Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Noelle Lucke-Wold
- Center for Basic and Translational Stroke Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Yasser Kabbani
- Department of Neuroradiology, Ruby Memorial Hospital, Morgantown, West Virginia, USA
| | - Abdul R. Tarabishy
- Department of Neuroradiology, Ruby Memorial Hospital, Morgantown, West Virginia, USA
| | - Paul D. Chantler
- Center for Cardiovascular and Respiratory Sciences, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Taura L. Barr
- Valtari Bio Incorporated, Morgantown, West Virginia, USA
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Monocyte to HDL cholesterol ratio is associated with discharge and 3-month outcome in patients with acute intracerebral hemorrhage. J Neurol Sci 2017; 372:157-161. [DOI: 10.1016/j.jns.2016.11.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 11/15/2022]
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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. Biomark Med 2017; 11:33-42. [PMID: 27917647 DOI: 10.2217/bmm-2016-0187] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: Inflammation plays a role in secondary brain injury after intracerebral hemorrhage (ICH). We aimed to determine the prognostic significance of admission white blood cell (AWC), neutrophil count (ANC), lymphocyte count, monocyte count and neutrophil to lymphocyte ratio (NLR) for 90-day outcome after ICH. Patients & methods: A total of 336 patients with spontaneous ICH were retrospectively investigated. Clinical outcome was assessed by modified Rankin Scale at 90 days. Results: Multivariate analysis showed that higher AWC, ANC, NLR were independently associated with mortality and worse outcome. Moreover, NLR showed a higher predictive ability in mortality than in poor outcome in receiver operating characteristic analysis. Linear regression analyses revealed admission Glasgow Coma Scale score and ICH volume were mostly correlated with these indices. Conclusion: Elevated levels of AWC, ANC and NLR were independently related to poor 90-day outcome after ICH. NLR may be a novel inflammatory biomarker following ICH.
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Affiliation(s)
- Chuanyuan Tao
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xin Hu
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Jiajing Wang
- Department of Critical Care Medicine, Neurosurgical Intensive Care Unit, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Junpeng Ma
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Hao Li
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Chao You
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
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Assessment of systemic cellular inflammatory response after spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg 2016; 150:72-79. [PMID: 27611984 DOI: 10.1016/j.clineuro.2016.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 10/22/2015] [Accepted: 07/03/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE After spontaneous intracerebral hemorrhage (ICH) a local and systemic inflammatory response is activated. Interleukin-6 (IL) is one of most relevant orchestrators of inflammatory responses in the brain and is released from multiple immune cells, including neutrophils. Herby we assessed the relevance of systemic inflammation in patients suffering ICH. METHODS From October 2010 to October 2011 we included in our routine of laboratory investigations besides to C-reactive protein (CRP), the addition of IL-6 and an analysis of the subpopulation of circulating blood cells. Values at admission, at 3rd and 7th day after admission were evaluated. We analyzed 43 patients with non-traumatic ICH; stroke-related ICH or tumor associated hemorrhage were excluded. Outcome variables were 30 and 90-day mortality and NIHSS at discharge. A natural logarithmic transformation of IL-6, lymphocytes, and monocytes was used. RESULTS 8.6% died within 30-days and mortality increased to 39.5% at 90th day. Total leukocytes and neutrophils as well as IL-6 at admission were statistically significant increased among patients who died within 30days after ICH onset (p=0.002). IL-6 and CRP in follow-up (3rd and 7th day) were higher among patients with poor outcome (NIHSS >15). The number of circulating lymphocytes and monocytes was not different in measurement. Leukocytes and neutrophils at 3rd day after admission were augmented in patients with respiratory infection and CRP in follow-up increased if some kind of infection was clinically or microbiologically detected. IL-6 at admission and in follow-up and monocytes at 7th day were related to ICH volume. CRP-values at 3rd or 7th day but not at admission were associated to bigger ICH-volume. The values of IL-6 were highly correlated to 30-day mortality and volume of ICH as CRP only with ICH volume. CONCLUSION After ICH onset a systemic activation of immune system seems to be induced and may be influencing outcome. Peripheral recruitment of leukocytes, especially neutrophils could be a target for future therapeutic interventions. Because of the tighter correlation of IL-6 at admission, it might be more accurate for prognostic issues than CRP.
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Morotti A, Phuah CL, Anderson CD, Jessel MJ, Schwab K, Ayres AM, Pezzini A, Padovani A, Gurol ME, Viswanathan A, Greenberg SM, Goldstein JN, Rosand J. Leukocyte Count and Intracerebral Hemorrhage Expansion. Stroke 2016; 47:1473-8. [PMID: 27103016 DOI: 10.1161/strokeaha.116.013176] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Acute leukocytosis is a well-established response to intracerebral hemorrhage (ICH). Leukocytes, because of their interaction with platelets and coagulation factors, may in turn play a role in hemostasis. We investigated whether admission leukocytosis was associated with reduced bleeding after acute ICH. METHODS Consecutive patients with primary ICH were prospectively collected from 1994 to 2015 and retrospectively analyzed. We included subjects with a follow-up computed tomographic scan available and automated complete white blood cell count performed within 48 hours from onset. Baseline and follow-up hematoma volumes were calculated with semiautomated software, and hematoma expansion was defined as volume increase >30% or 6 mL. The association between white blood cell count and ICH expansion was investigated with multivariate logistic regression. RESULTS A total of 1302 subjects met eligibility criteria (median age, 75 years; 55.8% men), of whom 207 (15.9%) experienced hematoma expansion. Higher leukocyte count on admission was associated with reduced risk of hematoma expansion (odds ratio for 1000 cells increase, 0.91; 95% confidence interval, 0.86-0.96; P=0.001). The risk of hematoma expansion was inversely associated with neutrophil count (odds ratio, 0.90; 95% confidence interval, 0.85-0.96; P=0.001) and directly associated with monocyte count (odds ratio, 2.71; 95% confidence interval, 1.08-6.83; P=0.034). There was no association between lymphocyte count and ICH expansion (odds ratio, 0.96; 95% confidence interval, 0.79-1.17; P=0.718). CONCLUSIONS Higher admission white blood cell count is associated with lower risk of hematoma expansion. This highlights a potential role of the inflammatory response in modulating the coagulation cascade after acute ICH.
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Affiliation(s)
- Andrea Morotti
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston.
| | - Chia-Ling Phuah
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Michael J Jessel
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Kristin Schwab
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alison M Ayres
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Pezzini
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Padovani
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - M Edip Gurol
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Joshua N Goldstein
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
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Lin X, Yu H, Zhao C, Qian Y, Hong D, Huang K, Mo J, Qin A, Fang X, Fan S. The Peripheral Blood Mononuclear Cell Count Is Associated With Bone Health in Elderly Men: A Cross-Sectional Population-Based Study. Medicine (Baltimore) 2016; 95:e3357. [PMID: 27082593 PMCID: PMC4839837 DOI: 10.1097/md.0000000000003357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The peripheral blood mononuclear cell (PBMC) count is a routinely used and meaningful index for infection and blood diseases. PBMCs may be closely related to osteoclasts and include osteoclast precursors; we examined the association between the PBMC count and bone health. This research included 2806 community men aged ≥50 years who underwent full health examinations from October 2007 through December 2011 in four medical centers. The PBMC count was significantly high among subjects with "at least osteopenia" compared with controls. In analysis of covariance adjusted for potential confounders, the bone mineral density (BMD) value and T-score had a significant decreasing trend across the quartiles of PBMC count. In univariate analysis, the PBMC count had a strong association with "at least osteopenia" (odds ratio [OR] = 2.520, 95% confidence interval [CI]: 1.397-4.547). After adjustment for confounding factors (multivariate analysis) from Model 1 to 4, PBMC count remained as an independent risk factor for "at least osteopenia" (OR = 2.481, 95% CI: 1.176-5.236). Moreover, after adjusting for all confounding variables, participants had a significantly high OR in the body mass index (BMI) <25 group (OR = 2.798, CI: 1.122-6.973; P = 0.027) and systolic blood pressure (SBP) <140 group (OR = 2.519, CI: 1.059-5.993; P = 0.037). In conclusion, the PBMC count is significantly associated with bone loss in elderly men and the exact mechanism requires further clarification.
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Affiliation(s)
- Xianfeng Lin
- From the Department of Orthopedic Surgery, Sir Run Run Shaw Hospital (XL, HY, KH, JM, XF, SF); Department of Orthopedic Surgery, the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou (CZ); Department of Orthopedic Surgery, Shaoxing People's Hospital, Shaoxing (YQ); Department of Orthopedic Surgery, Taizhou Hospital of Wenzhou Medical University, Linhai (DH); and Department of Orthopedic, Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai (AQ), China
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50
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Yu S, Arima H, Heeley E, Delcourt C, Krause M, Peng B, Yang J, Wu G, Chen X, Chalmers J, Anderson CS. White blood cell count and clinical outcomes after intracerebral hemorrhage: The INTERACT2 trial. J Neurol Sci 2015; 361:112-6. [PMID: 26810526 DOI: 10.1016/j.jns.2015.12.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 12/19/2015] [Accepted: 12/21/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Increased inflammatory reaction can aggravate brain injury after acute intracerebral hemorrhage, but the clinical effect of such response is not fully understood. The aim of this study was to determine associations of peripheral white blood cell (WBC) count on clinical outcome among participants of the INTERACT2 study. METHODS INTERACT2 was a randomized controlled trial of early intensive (target systolic level<140 mm Hg) compared to guideline-recommended (target systolic level < 180 mm Hg) blood pressure (BP) lowering in 2839 patients with acute ICH (<6h) and elevated systolic BP (150-220 mm Hg). Blood samples were collected on admission and WBC count was measured at local laboratories. The primary outcome was death or major disability, defined by scores 3-6 on the modified Rankin Scale at 90 days. Secondary outcome was death at 90 days. Associations of baseline WBC count and outcomes were evaluated in logistic regression models. INTERACT2 is registered with http://www.clinicaltrials.gov NCT00716079. RESULTS There were 2630 participants with relevant data who were classified into quartiles of WBC counts (≤ 6.22, 6.24-7.89, 7.90-10.17, and ≥ 10.20 × 10(9)/L, respectively). Increased WBC count was associated with younger age, elevated body temperature, increased glucose level, stroke severity, larger baseline hematoma volume, and intraventricular extension. Risks of death or major disability at 90 days increased progressively with higher WBC count: frequencies of 49.9%, 52.0%, 52.3% and 58.1% for quartile groups, respectively (P=0.004 for trend). However, after adjustment for baseline clinical and imaging variables including age, sex, region, lipid lowering therapy, body temperature, glucose, systolic BP, heart rate, high NIHSS scores, volume and location of hematoma, intraventricular extension, time from onset to CT scan, and randomized treatment, the association between WBC count and primary outcome was no longer significant (P=0.426 for trend). Patients with increased WBC count had significantly higher risk of death (P=0.0003 for trend), but again the association was no longer significant after adjustment for baseline clinical and imaging variables. CONCLUSIONS Elevated WBC count on admission is not an independent prognostic variable in patients with acute ICH.
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Affiliation(s)
- Sungwook Yu
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea; The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Hisatomi Arima
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Emma Heeley
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Candice Delcourt
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Martin Krause
- Department of Neurology, Royal North Shore Hospital, St Leonards, University of Sydney, Sydney, Australia
| | - Bin Peng
- Peking Union Medical College Hospital, Beijing, China
| | - Jie Yang
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Department of Neurology, Nanjing, Hospital affiliated to Nanjing Medical University, China
| | - Guojun Wu
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Department of Neurology, Hebei Yutian Hospital, China
| | - Xiaoying Chen
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
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