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Sun L, Ye X, Yu J, Wang L, Wu Y, Cui J, Dai L. Peripheral Lymphocyte-to-Monocyte Ratio as a Predictive Factor for Early Neurological Deterioration in Patients with Acute Ischemic Stroke. Int J Gen Med 2024; 17:4397-4405. [PMID: 39355340 PMCID: PMC11444228 DOI: 10.2147/ijgm.s483064] [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: 06/18/2024] [Accepted: 09/22/2024] [Indexed: 10/03/2024] Open
Abstract
Purpose Previous studies have reported that lymphocyte-to-monocyte ratio (LMR) is associated with the prognosis of patients with acute ischemic stroke (AIS); however, the relationship between LMR and early neurological deterioration (END) in AIS patients has not been elucidated. Patients and Methods Patients were divided into two groups according to LMR by using receiver operating characteristic (ROC) curve analysis. Patients with END were confirmed as the National Institutes of Health Stroke Scale (NIHSS) increased ≥ 4 points between hospital days 0 and 5. Multivariate logistic regression analysis was used to analyze the factors independently related to END in patients with AIS. Results In total, 202 patients diagnosed with AIS were enrolled in this retrospective study. Using ROC curve analysis, patients were divided into two groups according to LMR: low LMR group (LMR < 3.24, n = 95) and high LMR group (LMR ≥ 3.24, n = 107). The frequencies of END were significantly higher in the low LMR group compared to the high LMR group (41.05 vs.15.89%, p < 0.001). Multivariate logistic regression showed that age (OR = 1.03, 95% CI 1.01-1.06, p = 0.04), infarct volume (OR = 1.01, 95% CI 1.00-1.02, p = 0.001), neutrophil count (OR = 1.17, 95% CI 1.03-1.33, p = 0.018), and LMR (OR = 2.49, 95% CI 1.01-9.11, p = 0.018) were independently associated with END in AIS patients. Conclusion A peripheral LMR levels at admission were significantly associated with END and LMR < 3.24 is an independent predictive factor of END in patients with AIS.
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Affiliation(s)
- Liying Sun
- Intensive Care Unit, Shidong Hospital, Shanghai, People's Republic of China
| | - Xuhui Ye
- Intensive Care Unit, Shidong Hospital, Shanghai, People's Republic of China
| | - Junping Yu
- Intensive Care Unit, Shidong Hospital, Shanghai, People's Republic of China
| | - Linlin Wang
- Intensive Care Unit, Shidong Hospital, Shanghai, People's Republic of China
| | - Yan Wu
- Intensive Care Unit, Shidong Hospital, Shanghai, People's Republic of China
| | - Jing Cui
- Intensive Care Unit, Shidong Hospital, Shanghai, People's Republic of China
| | - Lihua Dai
- Intensive Care Unit, Shidong Hospital, Shanghai, People's Republic of China
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Li X, Zhou X, Wang H, Ruan B, Song Z, Zhang G. Association between lymphocyte-to-monocyte ratio and stroke-associated pneumonia: a retrospective cohort study. PeerJ 2024; 12:e18066. [PMID: 39677954 PMCID: PMC11639142 DOI: 10.7717/peerj.18066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/19/2024] [Indexed: 12/17/2024] Open
Abstract
Background Stroke-associated pneumonia (SAP) is a common complication of acute ischemic stroke (AIS) and is associated with increased mortality and prolonged hospital stays. The lymphocyte-to-monocyte ratio (LMR) is a novel inflammatory marker that has been shown to be associated with various diseases. However, the relationship between the LMR and SAP in patients with AIS remains unclear. Methods A retrospective cohort study was conducted on 1,063 patients with AIS admitted to our hospital within 72 hours of symptom onset. Patients were divided into two groups: the SAP group (n = 99) and the non-SAP group (n = 964). The LMR was measured within 24 hours of admission, and the primary outcome was the incidence of SAP. We used univariate and multivariate logistic regression analyses to assess the relationship between the LMR and SAP. Additionally, curve-fitting techniques and subgroup analyses were conducted. Result The incidence of SAP was 9.31%. We found that the LMR was significantly lower in the SAP group than in the non-SAP group (2.46 ± 1.44 vs. 3.86 ± 1.48, P < 0.001). A nonlinear relationship was observed between the LMR and the incidence of SAP. Subgroup analysis revealed that an elevated LMR was associated with a reduced incidence of SAP in individuals with an LMR below 4. Multivariate logistic regression analysis demonstrated that LMR was an independent predictor of SAP (OR = 0.37, 95% CI [0.27-0.53]). Conclusion Our study suggests that the LMR is an independent predictor of SAP in patients with AIS, particularly when the LMR is less than 4. The LMR may serve as a promising biomarker for the early identification of patients with AIS at a high risk of SAP.
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Affiliation(s)
- Xiaoqiang Li
- Department of Neurology, Xiaolan People’s Hospital of Zhongshan (The Fifth People’s Hospital of Zhongshan), Zhongshan, Guangdong, China
| | - Xiangmao Zhou
- Department of Gastrointestinal Surgery, The Central Hospital of Yongzhou, Yongzhou, Hunan, China
| | - Hui Wang
- Department of Neurology, Xiaolan People’s Hospital of Zhongshan (The Fifth People’s Hospital of Zhongshan), Zhongshan, Guangdong, China
| | - Baifu Ruan
- Department of Neurology, Xiaolan People’s Hospital of Zhongshan (The Fifth People’s Hospital of Zhongshan), Zhongshan, Guangdong, China
| | - Zhibin Song
- Department of Neurology, Xiaolan People’s Hospital of Zhongshan (The Fifth People’s Hospital of Zhongshan), Zhongshan, Guangdong, China
| | - Guifeng Zhang
- Department of Neurology, Xiaolan People’s Hospital of Zhongshan (The Fifth People’s Hospital of Zhongshan), Zhongshan, Guangdong, China
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Wang J, Wang G, Cheng L, Zhu H, Wang J, Ding X, Niu H, Zhao K, Shu K. Preoperative peripheral inflammatory markers are predictors of postoperative central diabetes insipidus in craniopharyngioma patients: a retrospective study. BMC Cancer 2024; 24:572. [PMID: 38720306 PMCID: PMC11080258 DOI: 10.1186/s12885-024-12324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Postoperative central diabetes insipidus (CDI) is commonly observed in craniopharyngioma (CP) patients, and the inflammatory response plays an important role in CPs. We aimed to evaluate the predictive value of preoperative peripheral inflammatory markers and their combinations regarding CDI occurrence in CPs. METHODS The clinical data including preoperative peripheral inflammatory markers of 208 CP patients who underwent surgical treatment were retrospectively collected and analyzed. The preoperative peripheral white blood cells (WBC), neutrophils, lymphocytes, monocytes, platelet (PLT), neutrophil-to-lymphocyte ratio (NLR), derived-NLR (dNLR), monocyte-to-lymphocyte ratio (MLR) and PLT-to-lymphocyte ratio (PLR) were assessed in total 208 CP patients and different age and surgical approach CP patient subgroups. Their predictive values were evaluated by the receiver operator characteristic curve analysis. RESULTS Preoperative peripheral WBC, neutrophils, NLR, dNLR, MLR, and PLR were positively correlated and lymphocyte was negatively associated with postoperative CDI occurrence in CP patients, especially when WBC ≥ 6.66 × 109/L or lymphocyte ≤ 1.86 × 109/L. Meanwhile, multiple logistic regression analysis showed that WBC > 6.39 × 109/L in the > 18 yrs age patients, WBC > 6.88 × 109/L or lymphocytes ≤ 1.85 × 109/L in the transcranial approach patients were closely associated with the elevated incidence of postoperative CDI. Furthermore, the area under the curve obtained from the receiver operator characteristic curve analysis showed that the best predictors of inflammatory markers were the NLR in total CP patients, the MLR in the ≤ 18 yrs age group and the transsphenoidal group, the NLR in the > 18 yrs age group and the dNLR in the transcranial group. Notably, the combination index NLR + dNLR demonstrated the most valuable predictor in all groups. CONCLUSIONS Preoperative peripheral inflammatory markers, especially WBC, lymphocytes and NLR + dNLR, are promising predictors of postoperative CDI in CPs.
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Affiliation(s)
- Jing Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Guanghui Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lidong Cheng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongtao Zhu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xinmin Ding
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Hongquan Niu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kai Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Zhang BW, Sun KH, Liu T, Zou W. The Crosstalk Between Immune Cells After Intracerebral Hemorrhage. Neuroscience 2024; 537:93-104. [PMID: 38056621 DOI: 10.1016/j.neuroscience.2023.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/28/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023]
Abstract
The inflammatory mechanism of intracerebral hemorrhage (ICH) has been widely studied, and it is believed that the regulation of this mechanism is of great significance to the prognosis. In the early stage of the acute phase of ICH, the release of a large number of inflammatory factors around the hematoma can recruit more inflammatory cells to infiltrate the area, further release inflammatory factors, cause an inflammatory cascade reaction, aggravate the volume of cerebral hematoma and edema and further destroy the blood-brain barrier (BBB), according to this, the crosstalk between cells may be of great significance in secondary brain injury (SBI). Because most of the cells recruited are inflammatory immune cells, this paper mainly discusses the cells based on the inflammatory mechanism to discuss their functions after ICH, we found that among the main cells inherent in the brain, glial cells account for the majority, of which microglia are the most widely studied and it can interact with a variety of cells, which is reflected in the literature researches on its pathogenesis and treatment. We believe that exploring multi-mechanism and multi-cell regulated drugs may be the future development trend, and the existing research, the comparison and unification of modeling methods, and the observation of long-term efficacy may be the first problem that researchers need to solve.
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Affiliation(s)
- Bai-Wen Zhang
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Ke-Han Sun
- Rehabilitation Department, Maternal and Child Health Hospital of Xing-an League, Ulanhot City, Inner Mongolia 137400, China
| | - Ting Liu
- Rehabilitation Department, Pengzhou Traditional Chinese Medicine Hospital, Chengdu 611930, China
| | - Wei Zou
- The Third Acupuncture Department, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150040, China.
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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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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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Albakr A, Almatar A, AlFajri A, Zafar A, Nazish S, Shahid R, AlJaafari D, Soltan N, Alarfaj Z, Al Ghamdi O, Alfilw S, Abdelhady A, Albaker W. Important Factors to Expect the Outcome After Intracerebral Hemorrhage: An Observational Study From a University Hospital in Saudi Arabia. Neurologist 2023; 28:310-315. [PMID: 37027177 DOI: 10.1097/nrl.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) has worse clinical outcomes than other stroke types. The risk factors contributing to ICH outcomes are not entirely understood, and published literature from Saudi Arabia on ICH outcomes is limited. Our goal was to study the specific clinical and imaging determinants of ICH outcomes. METHODS We retrospectively retrieved all patients with spontaneous ICH (SICH) from a prospective King Fahd Hospital University registry between 2017 and 2019. The clinical characteristics of ICH events and data on clinical outcomes (6 to 12 mo) were recorded. Groups of patients with a favorable modified Rankin Scale of 0 to 2 and nonfavorable outcomes of a modified Rankin Scale of 3 to 6 were investigated. The relationship between the clinical characteristics of the SICH event and its outcomes was assessed using linear and logistic regression analyses. RESULTS A total of 148 patients with a mean age of 60.3 years (±15.2) and a median follow-up of 9 months were included. Unfavorable outcomes were reported in 98 patients (66.2%). The ICH event variables associated with unfavorable outcomes were impaired renal function, Glasgow Coma Score <8, hematoma volume, hematoma expansion, and intraventricular extension (IVE). CONCLUSIONS Our study demonstrated important clinical and radiologic features in patients with ICH that may affect their clinical long-term functional outcomes. A larger multicenter study is required to validate our results and evaluate the methods to improve health care in patients with SICH.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Suad Alfilw
- Department of Neurology, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Ahmed Abdelhady
- Department of critical care, College of Medicine, Alexandria University, Egypt
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Liang Z, Liu H, Xue L, Ma B, Yang LZ, Liang QL, Zhou ZM. A retrospective study about association of dynamic systemic immune-inflammation index (SII) with 180-day functional outcome after basal ganglia intracerebral hemorrhage. Heliyon 2023; 9:e16937. [PMID: 37484257 PMCID: PMC10361026 DOI: 10.1016/j.heliyon.2023.e16937] [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: 01/06/2023] [Revised: 04/13/2023] [Accepted: 06/01/2023] [Indexed: 07/25/2023] Open
Abstract
Objectives This study aimed to determine whether SII on different days of admission is associated with severity and 180-day functional outcomes after basal ganglia ICH. Methods In this retrospective study, data on baseline CT imaging characteristics, mRS, hematoma volume, and laboratory variables were included. The SII and NLR, LMR, and PLR were calculated from laboratory data collected on admission day, day 1, and days 5-7. Both univariate and multivariable logistic regression analyses were used to assess the association between the SII and the outcome. The receiver operating characteristic (ROC) analysis and area under the curve (AUC) were also used to evaluate the ability of the SII to predict outcomes. Result A total of 245 patients were enrolled in the study. On different days, the NLR, PLR, and SII were significantly lower in patients with favorable outcomes than in those with poor outcomes, and the volume of hemorrhage was positively correlated with the SII. These parameters were associated with outcomes in the univariate logistic regression. In the adjusted analyses, the SII and PLR were independent predictors of basal ganglia ICH outcomes. ROC analysis revealed that the SII showed a stronger ability to predict the 6-month outcomes of patients after basal ganglia ICH than the PLR on different days (AUC = 0.642, 0.804, 0.827 vs. 0.592, 0.725, 0.757; all P < 0.001). Conclusion The SII independently and strongly predicts the outcome of basal ganglia ICH. A high SII was associated with poor 6-month outcomes in patients with basal ganglia ICH.
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Affiliation(s)
- Zhang Liang
- Department of Neurosurgery, Dujiangyan Medical Center, Chengdu, China
| | - He Liu
- Department of Radiology, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Li Xue
- Department of Orthopaedics, The 3rd People’s Hospital of Chengdu, College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Bin Ma
- Human Anatomy, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Ling-Zhi Yang
- Department of Clinical Laboratory Medicine, Dujiangyan Medical Center, Chengdu, China
| | - Qing-Le Liang
- Department of Clinical Laboratory Medicine, Jiangjin Affiliated Hospital, Chongqing University, Chongqing, China
| | - Zhang-Ming Zhou
- Department of Neurosurgery, Dujiangyan Medical Center, Chengdu, China
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Mehta NH, Zhou L, Li Y, McIntire LB, Nordvig A, Butler T, de Leon M, Chiang GC. Peripheral immune cell imbalance is associated with cortical beta-amyloid deposition and longitudinal cognitive decline. Sci Rep 2023; 13:8847. [PMID: 37258519 PMCID: PMC10232445 DOI: 10.1038/s41598-023-34012-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/22/2023] [Indexed: 06/02/2023] Open
Abstract
Neuroinflammation is believed to be a key process in Alzheimer's disease (AD) pathogenesis. Recently, the neutrophil-to-lymphocyte (NLR) and lymphocyte-to-monocyte ratios (LMR) have been proposed to be useful peripheral markers of inflammation. However, it is unclear how these inflammatory ratios relate to AD pathology, such as β-amyloid (Aβ) plaques and tau tangles. Using 18F-florbetapir and 18F-flortaucipir positron emission tomography (PET), we sought to determine how the NLR and LMR are associated with AD pathology both cross-sectionally and longitudinally. We further evaluated associations between the NLR and LMR and longitudinal cognitive decline. Using data from the Alzheimer's Disease Neuroimaging Initiative, we analyzed blood, PET, and cognitive data from 1544 subjects-405 cognitively normal, 838 with mild cognitive impairment (MCI), and 301 with AD. Associations between the NLR and LMR and Aβ and tau on PET were assessed using ordinary least-squares and mixed-effects regression models, while adjusting for age, sex, years of education, and apolipoprotein E ε2 or ε4 carrier status. Associations between the NLR and LMR and cognitive function, as measured by the AD Assessment Scale-Cognitive Subscale, 13-item version, were also assessed. MCI and AD subjects had higher NLR (p = 0.017, p < 0.001, respectively) and lower LMR (p = 0.013, p = 0.023). The NLR, but not the LMR, was significantly associated with Aβ (p = 0.028), suggesting that higher NLR was associated with greater Aβ deposition in the brain. Neither the NLR nor the LMR was associated with tau deposition (p > 0.05). A higher NLR was associated with greater longitudinal cognitive decline (p < 0.001). A higher ratio of peripheral neutrophils to lymphocytes, possibly reflecting an imbalance in innate versus adaptive immunity, is related to greater Aβ deposition and longitudinal cognitive decline. As the field moves toward blood-based biomarkers of AD, the altered balance of innate versus adaptive immunity could be a useful biomarker of underlying pathology and may also serve as a potential therapeutic target.
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Affiliation(s)
- Neel H Mehta
- Department of Biology, Cornell University, Ithaca, NY, 14850, USA
| | - Liangdong Zhou
- Brain Health Imaging Institute, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 407 E 61st Street, New York, NY, 10065, USA
| | - Yi Li
- Brain Health Imaging Institute, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 407 E 61st Street, New York, NY, 10065, USA
| | - Laura Beth McIntire
- Brain Health Imaging Institute, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 407 E 61st Street, New York, NY, 10065, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10065, USA
| | - Anna Nordvig
- Department of Neurology, Alzheimer's Disease and Memory Disorders Program, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 428 East 72nd Street Suite 500, New York, NY, 10021, USA
| | - Tracy Butler
- Brain Health Imaging Institute, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 407 E 61st Street, New York, NY, 10065, USA
| | - Mony de Leon
- Brain Health Imaging Institute, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 407 E 61st Street, New York, NY, 10065, USA
| | - Gloria C Chiang
- Brain Health Imaging Institute, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 407 E 61st Street, New York, NY, 10065, USA.
- Department of Radiology, Division of Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, Box 141, New York, NY, 10065, USA.
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Chu H, Huang C, Zhou Z, Tang Y, Dong Q, Guo Q. Inflammatory score predicts early hematoma expansion and poor outcomes in patients with intracerebral hemorrhage. Int J Surg 2023; 109:266-276. [PMID: 37093070 PMCID: PMC10389560 DOI: 10.1097/js9.0000000000000191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/20/2022] [Indexed: 04/25/2023]
Abstract
BACKGROUND This study aimed to develop a prediction score named inflammatory score based on proper integration of several inflammatory markers and investigate whether it was associated with hematoma expansion and poor outcomes in patients with intracerebral hemorrhage (ICH). METHODS This study involved a consecutive series of spontaneous ICH patients of two cohorts admitted within 24 hours after symptom onset. Inflammatory score (0-9) was developed with the combination of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, lactate dehydrogenase, and C-reactive protein. The authors investigated the association between inflammatory score and hematoma expansion and poor outcomes by using univariate and multivariate logistic regression analyses. The optimal cutoff point of inflammatory score was determined by receiver operating characteristic analysis in the development cohort and then validated. RESULTS A total of 301 and 154 ICH patients were enrolled in the development and validation cohorts. Inflammatory score was significantly higher in patients with hematoma expansion and poor outcomes. The multivariate logistic regression analysis revealed inflammatory score was independently associated with hematoma expansion, secondary neurological deterioration within 48 hours, 30-day mortality, and 3-month poor modified Rankin scale (4-6). The diagnostic accuracy of inflammatory score exhibited by area under the curve showed numerically or statistically higher than most of the individual indicators. Moreover, inflammatory score greater than or equal to 5 was selected as the optimal cutoff point, which was further prospectively validated with high diagnostic accuracy. CONCLUSIONS The inflammatory score is a reliable predictor for early hematoma expansion and short-term and long-term poor outcomes with good diagnostic accuracies in ICH patients.
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Affiliation(s)
- Heling Chu
- Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - Chuyi Huang
- Health Management Center, School of Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University
| | - Zaiying Zhou
- Center for Statistical Science of Tsinghua University, Beijing, China
| | - Yuping Tang
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai
| | - Qiang Dong
- Center for Statistical Science of Tsinghua University, Beijing, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
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11
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Wang J, Wang W, Wang A, Zhang X, Bian L, Du Y, Lu J, Zhao X. Slightly Elevated Lymphocyte to Monocyte Ratio Predicting Favorable Outcomes in Patients with Spontaneous Intracerebral Hemorrhage. J Inflamm Res 2022; 15:6773-6783. [PMID: 36560932 PMCID: PMC9766528 DOI: 10.2147/jir.s390557] [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: 09/20/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Objective This study was designed to determine the association between admission lymphocyte to monocyte ratio (LMR) values and clinical outcomes in patients with spontaneous intracerebral hemorrhage (ICH). Methods We used a prospective and registry-based database, and ICH patients were consecutively recruited in Beijing Tiantan Hospital between January 2014 and September 2016. All participants were stratified by quartiles of the LMR. Univariable and multivariable logistic regression analyses were plotted to evaluate the association between LMR levels and functional outcomes. Kaplan-Meier survival curves and Cox regression analysis were also performed to examine the relevance between different LMR quartiles and case fatality at follow-up. Results Six hundred and forty patients with spontaneous ICH were finally included in this study. Compared with the patients with LMR values in quartile 1 (Q1), slightly elevated LMR values showed a negative correlation with risks of poor short-term outcomes (adjusted ORs in Q2 were 0.572 [95% CI: 0.338-0.968] at 1 month, 0.515 [95% CI: 0.305-0.871] at 3 months). Patients with LMR values in Q1 had the highest cumulative death rate. A slightly elevated LMR was also independently relevant to a deduced mortality rate compared to that in Q1 (adjusted HRs in Q2 were 0.471 [95% CI: 0.274-0.809] at 1 month, 0.474 [95% CI: 0.283-0.793] at 3 months, 0.575 [95% CI: 0.361-0.917] at 1 year). Additionally, a higher LMR value was associated with a lower risk of in-hospital infections. Conclusion This study suggests that a lower LMR value is associated with higher risks of in-hospital infections, poor functional outcomes, and follow-up mortality in patients with ICH. However, a slightly elevated LMR value, especially in Q2, relates to a favorable prognosis, which may reflect an inner balance between inflammation and immunodepression and thus provides a promising marker for predicting ICH prognosis.
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Affiliation(s)
- Jinjin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China,China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Wenjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China,China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China,China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China,China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Liheng Bian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China,China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Yang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China,China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Jingjing Lu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China,China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China,China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China,Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Xingquan Zhao; Jingjing Lu, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86-10-59978555, Fax +86-10-83191171, Email ;
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12
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Hu L, Yu J, Deng J, Zhou H, Yang F, Lu X. Development of nomogram to predict in-hospital death for patients with intracerebral hemorrhage: A retrospective cohort study. Front Neurol 2022; 13:968623. [PMID: 36504658 PMCID: PMC9729245 DOI: 10.3389/fneur.2022.968623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Aim This study aimed to investigate the association between systemic immune-inflammation (SII) and the risk of in-hospital death for patients with intracerebral hemorrhage (ICH) in the intensive care units (ICU) and to further develop a prediction model related to SII in predicting the risk of in-hospital death for patients with ICH. Methods In this retrospective cohort study, we included 1,176 patients with ICH from the Medical Information Mart for Intensive Care III (MIMIC-III) database. All patients were randomly assigned to the training group for the construction of the nomogram and the testing group for the validation of the nomogram based on a ratio of 8:2. Predictors were screened by the least absolute shrinkage and selection operator (LASSO) regression analysis. A multivariate Cox regression analysis was used to investigate the association between SII and in-hospital death for patients with ICH in the ICU and develop a model for predicting the in-hospital death risk for ICU patients with ICH. The receiver operator characteristic curve was used to assess the predicting performance of the constructed nomogram. Results In the training group, 232 patients with ICH died while 708 survived. LASSO regression showed some predictors, including white blood cell count, glucose, blood urea nitrogen, SII, the Glasgow Coma Scale, age, heart rate, mean artery pressure, red blood cell, bicarbonate, red blood cell distribution width, liver cirrhosis, respiratory failure, renal failure, malignant cancer, vasopressor, and mechanical ventilation. A prediction model integrating these predictors was established. The area under the curve (AUC) of the nomogram was 0.810 in the training group and 0.822 in the testing group, indicating that this nomogram might have a good performance. Conclusion Systemic immune-inflammation was associated with an increased in-hospital death risk for patients with ICH in the ICU. A nomogram for in-hospital death risk for patients with ICH in the ICU was developed and validated.
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Affiliation(s)
- Linwang Hu
- Department of Neurosurgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jie Yu
- Department of Neurosurgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jian Deng
- Department of Neurosurgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hong Zhou
- Department of Neurosurgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Feng Yang
- Department of Pharmacy, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Xiaohang Lu
- Department of Critical Care Medicine, People's Hospital of Ningxia Hui Autonomous Region, Ningxia, China,*Correspondence: Xiaohang Lu
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Qin J, Wei H, Liu Y, Du L, Xia J. Association between leukocyte subpopulations and hematoma expansion after spontaneous intracerebral hemorrhage: A retrospective cohort study. Front Neurol 2022; 13:992851. [PMID: 36147038 PMCID: PMC9485931 DOI: 10.3389/fneur.2022.992851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Aims To verify the association between leukocyte subpopulations and hematoma expansion (HE) determined by two definitions in Chinese individuals who experienced spontaneous intracerebral hemorrhage. Methods We enrolled 471 patients. The 1/2ABC formula was used to gauge hematoma volume. The outcome was whether HE appeared within 72 h. We used Definition 1 (volume increase ≥6 mL or 33%) and Definition 2 (volume increase ≥12.5 mL or 33%) to define HE, respectively. Binary logistic regression analysis was used to assess the association between leukocyte subpopulations and HE. For statistically significant leukocyte subpopulations, we also performed subgroup analyses to assess differences between subgroups. Results Among 471 patients, 131 (27.81%) and 116 (24.63%) patients experienced HE based on Definition 1 and Definition 2, respectively. After adjusting for confounding factors, elevated monocyte count was associated with a higher risk of HE-Definition 1 [adjusted odds ratio (aOR) 2.45, 95% confidence interval (CI) 1.02–5.88, P = 0.0450] and HE-Definition 2 (aOR 2.54, 95% CI 1.04–6.20, P = 0.0399). Additionally, we compared the results before and after adjusting for coagulation parameters. Monocyte count was significantly correlated with HE only after adjusting for coagulation parameters. Increased neutrophil count was associated with a lower risk of HE-Definition 1 (aOR 0.91, 95% CI 0.84–1.00, P = 0.0463). No correlations were observed between lymphocyte and leukocyte counts and HE (P > 0.05), and no subgroup interactions were observed (interaction P > 0.05). Conclusion A higher monocyte count is associated with a higher HE risk regardless of the two definitions, after excluding the influence of the coagulation parameters, which facilitates risk stratification. Moreover, an increased neutrophil count is associated with a decreased risk of HE in the context of HE-Definition 1, which reflects the importance of standardizing the definition of HE.
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Affiliation(s)
- Jiao Qin
- Department of Radiology, Shenzhen Longhua District Central Hospital, Shenzhen, China
- Guangzhou Medical University, Guangzhou, China
| | - Haihua Wei
- Department of Nuclear Medicine, The First People's Hospital of Foshan, Foshan, China
| | - Yuling Liu
- Department of Radiology, Shenzhen Futian District Second People's Hospital, Shenzhen, China
| | - Lixin Du
- Department of Radiology, Shenzhen Longhua District Central Hospital, Shenzhen, China
- *Correspondence: Lixin Du
| | - Jun Xia
- Department of Radiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Jun Xia
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14
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Neutrophil-to-Lymphocyte Ratio and Early Neurological Deterioration in Stroke Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8656864. [PMID: 36033552 PMCID: PMC9402292 DOI: 10.1155/2022/8656864] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 12/26/2022]
Abstract
In light of the growing emphasis on classifying stroke patients for different levels of monitoring intensity and emergency treatments, we conducted a systematic review of a wide range of clinical studies, according to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, with no restrictions on the language or publication date, to analyze the potential of the neutrophil-to-lymphocyte ratio (NLR) as an early neurological deterioration (END) risk predictor. A comprehensive search was carried out in PubMed, Scopus, and Web of Science databases from the inception to March 13, 2022. Nine articles were included in our study. Stroke patients with END had significantly higher NLR levels than the those without END (SMD = 0.73; CI 95% = 0.42-1.05, P value < 0.001). In the subgroup analysis, according to ethnicity, East Asian patients with END had elevated levels of NLR compared to those without END (SMD = 0.79; CI 95% = 0.52-1.06, P value < 0.001). However, the difference in the Caucasian group was not significant (SMD = 0.60; CI 95% = -0.50-1.70, P value = 0.28). In the subgroup analysis according to the type of stroke, the NLR levels in patients with hemorrhagic stroke who developed END were similar to those without END (SMD = 0.84, CI 95% = -0.10-1.77, P value = 0.07). Vice versa, in the ischemic stroke group, patients with END had elevated levels of NLR compared to those without END (SMD = 0.67, CI 95% = 0.38-0.96, P value < 0.001). NLR is a unique inflammatory biomarker whose increase in END suggests an immune system dysfunction in the pathogenesis of the disease.
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He Q, Guo H, Bi R, Chen S, Shen J, Long C, Li M, Xia Y, Zhang L, Sun Z, Chen X, Wang Z, Gong D, Xu J, Zhu D, Wan Y, Hu B. Prediction of Neurological Deterioration After Intracerebral Hemorrhage: The SIGNALS Score. J Am Heart Assoc 2022; 11:e026379. [PMID: 35916347 PMCID: PMC9375508 DOI: 10.1161/jaha.122.026379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Intracerebral hemorrhage is the most disabling and lethal form of stroke. We aimed to develop a novel clinical score for neurological deterioration during hospitalization after intracerebral hemorrhage. Methods and Results We analyzed data from the CHERRY (Chinese Cerebral Hemorrhage: Mechanism and Intervention) study. Two-thirds of eligible patients were randomly allocated into the training cohort (n=1027) and one-third into the validation cohort (n=515). Multivariable logistic regression was used to identify factors associated with neurological deterioration (an increase in National Institutes of Health Stroke Scale of ≥4 or death) within 15 days after symptom onset. A prediction score was developed based on regression coefficients derived from the logistic model. The site, size, gender, National Institutes of Health Stroke Scale, age, leukocyte, sugar (SIGNALS) score was developed as a sum of individual points (0-8) based on site (1 point for infratentorial location), size (3 points for >20 mL of supratentorial hematoma volume or 2 points for >10 mL of infratentorial hematoma volume), sex (1 point for male sex), National Institutes of Health Stroke Scale score (1 point for >10), age (1 point for ≥70 years), white blood cell (1 point for>9.0×109/L), and fasting blood glucose (1 point>7.0 mmol/L). The proportion of patients who suffered from neurological deterioration increased with higher SIGNALS score, showing good discrimination and good calibration in the training cohort (C statistic, 0.821; Hosmer-Lemeshow test, P=0.687) and in the validation cohort (C statistic, 0.848; Hosmer-Lemeshow test, P=0.592), respectively. Conclusions The SIGNALS score reliably predicts the risk of in-hospital neurological deterioration of patients with intracerebral hemorrhage.
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Affiliation(s)
- Quanwei He
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Hongxiu Guo
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Shaoli Chen
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Jing Shen
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Chunnan Long
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Yuanpeng Xia
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Zhou Sun
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Xiaolu Chen
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Zhaowei Wang
- Department of Neurology Qianjiang Central Hospital Qianjiang Hubei Province China
| | - Daokai Gong
- Department of Neurology Jingzhou Central Hospital Jingzhou Hubei Province China
| | - Jingwen Xu
- Department of Neurology Honghu People's Hospital Honghu Hubei Province China
| | - Dondya Zhu
- School of Pharmacy Nanjing Medical University Nanjing Jiangsu Province China
| | - Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
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He Q, Guo H, Bi R, Chen S, Shen J, Long C, Li M, Xia Y, Zhang L, Sun Z, Chen X, Wang Z, Gong D, Xu J, Zhu D, Wan Y, Hu B. Prediction of Neurological Deterioration After Intracerebral Hemorrhage: The SIGNALS Score. J Am Heart Assoc 2022. [PMID: 35862193 DOI: 10.1161/jaha.121.026379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intracerebral hemorrhage is the most disabling and lethal form of stroke. We aimed to develop a novel clinical score for neurological deterioration during hospitalization after intracerebral hemorrhage. Methods and Results We analyzed data from the CHERRY (Chinese Cerebral Hemorrhage: Mechanism and Intervention) study. Two-thirds of eligible patients were randomly allocated into the training cohort (n=1027) and one-third into the validation cohort (n=515). Multivariable logistic regression was used to identify factors associated with neurological deterioration (an increase in National Institutes of Health Stroke Scale of ≥4 or death) within 15 days after symptom onset. A prediction score was developed based on regression coefficients derived from the logistic model. The site, size, gender, National Institutes of Health Stroke Scale, age, leukocyte, sugar (SIGNALS) score was developed as a sum of individual points (0-8) based on site (1 point for infratentorial location), size (3 points for >20 mL of supratentorial hematoma volume or 2 points for >10 mL of infratentorial hematoma volume), sex (1 point for male sex), National Institutes of Health Stroke Scale score (1 point for >10), age (1 point for ≥70 years), white blood cell (1 point for>9.0×109/L), and fasting blood glucose (1 point>7.0 mmol/L). The proportion of patients who suffered from neurological deterioration increased with higher SIGNALS score, showing good discrimination and good calibration in the training cohort (C statistic, 0.821; Hosmer-Lemeshow test, P=0.687) and in the validation cohort (C statistic, 0.848; Hosmer-Lemeshow test, P=0.592), respectively. Conclusions The SIGNALS score reliably predicts the risk of in-hospital neurological deterioration of patients with intracerebral hemorrhage.
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Affiliation(s)
- Quanwei He
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Hongxiu Guo
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Shaoli Chen
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Jing Shen
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Chunnan Long
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Yuanpeng Xia
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Zhou Sun
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Xiaolu Chen
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Zhaowei Wang
- Department of Neurology Qianjiang Central Hospital Qianjiang Hubei Province China
| | - Daokai Gong
- Department of Neurology Jingzhou Central Hospital Jingzhou Hubei Province China
| | - Jingwen Xu
- Department of Neurology Honghu People's Hospital Honghu Hubei Province China
| | - Dondya Zhu
- School of Pharmacy Nanjing Medical University Nanjing Jiangsu Province China
| | - Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
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17
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Zhu L, Huang L, Le A, Wang TJ, Zhang J, Chen X, Wang J, Wang J, Jiang C. Interactions between the Autonomic Nervous System and the Immune System after Stroke. Compr Physiol 2022; 12:3665-3704. [PMID: 35766834 DOI: 10.1002/cphy.c210047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute stroke is one of the leading causes of morbidity and mortality worldwide. Stroke-induced immune-inflammatory response occurs in the perilesion areas and the periphery. Although stroke-induced immunosuppression may alleviate brain injury, it hinders brain repair as the immune-inflammatory response plays a bidirectional role after acute stroke. Furthermore, suppression of the systemic immune-inflammatory response increases the risk of life-threatening systemic bacterial infections after acute stroke. Therefore, it is essential to explore the mechanisms that underlie the stroke-induced immune-inflammatory response. Autonomic nervous system (ANS) activation is critical for regulating the local and systemic immune-inflammatory responses and may influence the prognosis of acute stroke. We review the changes in the sympathetic and parasympathetic nervous systems and their influence on the immune-inflammatory response after stroke. Importantly, this article summarizes the mechanisms on how ANS regulates the immune-inflammatory response through neurotransmitters and their receptors in immunocytes and immune organs after stroke. To facilitate translational research, we also discuss the promising therapeutic approaches modulating the activation of the ANS or the immune-inflammatory response to promote neurologic recovery after stroke. © 2022 American Physiological Society. Compr Physiol 12:3665-3704, 2022.
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Affiliation(s)
- Li Zhu
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Leo Huang
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Anh Le
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Tom J Wang
- Winston Churchill High School, Potomac, Maryland, USA
| | - Jiewen Zhang
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xuemei Chen
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, PR China
| | - Junmin Wang
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, PR China
| | - Jian Wang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.,Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, PR China
| | - Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Shi M, Li XF, Zhang TB, Tang QW, Peng M, Zhao WY. Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Front Neurosci 2022; 16:825859. [PMID: 35360156 PMCID: PMC8960242 DOI: 10.3389/fnins.2022.825859] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) plays an important role in the progression of intracerebral hemorrhage (ICH). An increasing number of studies have reported that a high NLR is correlated with poor clinical outcomes among patients with ICH. Here, we conducted a systematic review and meta-analysis to evaluate the prognostic value of NLR in the setting of ICH. We performed a comprehensive search of electronic literature databases to identify all relevant studies evaluating the prognostic role of NLR in patients with ICH. Two researchers independently screened the studies and extracted relevant data. We extracted, pooled, and weighted odds ratio (OR) and 95% confidence interval (CI) values using a generic inverse-variance method, and then evaluated the heterogeneity among studies using Q test and I2 statistic. Finally, we selected a total of 26 studies including 7,317 patients for the current study. Overall, our results indicated that a high NLR was significantly associated with a poor outcome (OR, 1.32; 95% CI, 1.19–1.46; P < 0.00001), mortality (OR, 1.05; 95% CI, 1.01–1.09; P = 0.02), and neurological deterioration (OR, 1.65; 95% CI, 1.08–2.52; P = 0.02). We did not observe a significant association between NLR and hematoma expansion (OR, 1.04; 95% CI, 0.99–1.08; P = 0.09). Our study indicated that a high NLR is significantly associated with poor clinical outcomes in patients with ICH. As NLR is a simple and easily available biomarker, future studies should focus on exploring its application in the prognostic evaluation of patients with ICH.
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Affiliation(s)
- Min Shi
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiao-feng Li
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ting-bao Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qing-wen Tang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mian Peng
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Mian Peng,
| | - Wen-yuan Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Wen-yuan Zhao,
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19
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Huang WC, Lin HC, Yang YH, Hsu CW, Chen NC, Tsai WC, Cheng BC, Tsai NW. Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are associated with a 2-year relapse in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 58:103514. [PMID: 35032880 DOI: 10.1016/j.msard.2022.103514] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between increased neutrophil-to-lymphocyte ratio (NLR) and multiple sclerosis has been demonstrated in several studies. The monocyte-to-lymphocyte ratio (MLR) is an emerging biomarker for disease monitoring. Moreover, there has not been a published Taiwanese study to date. AIM To investigate the correlation of NLR, MLR and white blood cell (WBC) count as possible biomarkers for predicting a 2-year relapse in patients with multiple sclerosis (MS). MATERIALS AND METHODS A total of 641 Taiwanese patients with MS were enrolled in the present study between January 1, 2001, and December 31, 2018. We collected data on NLR, MLR, WBC count, disease-modifying therapy (DMT) use, and the time between first diagnosis and first relapse in all patients within a 2-year duration. RESULTS In the relapse group, there were significantly more patients with NLR >median or MLR >median (p = 0.006 and p = 0.020, respectively). There were also more patients with WBC count >median, although the difference was not statically significant (p = 0.069). The adjusted hazard ratio for relapse and NLR >median was 1.61(p = 0.008). The adjusted hazard ratio for relapse and MLR >median was 1.43 (p = 0.044). Patients with NLR >median or MLR >median had a significantly (p = 0.008 and p = 0.039, respectively) increased risk of MS relapse in the 2 years, compared with those who had NLR <median or MLR <median. CONCLUSION NLR and MLR are widely available, fast and measurable inflammatory markers for predicting the relapse risk of MS patients.
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Affiliation(s)
- Wei-Chin Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Chen Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Che-Wei Hsu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Ching Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wan-Chen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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20
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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: 0.3] [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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21
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Acute Inflammation in Cerebrovascular Disease: A Critical Reappraisal with Focus on Human Studies. Life (Basel) 2021; 11:life11101103. [PMID: 34685473 PMCID: PMC8540384 DOI: 10.3390/life11101103] [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: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Recent attention has been focused on the field of inflammatory biomarkers associated with vascular disorders, regarding diagnosis, prognosis, and possible therapeutical targets. In this study, we aimed to perform a comprehensive review of the literature regarding the use of inflammatory biomarkers in stroke patients. We searched studies that evaluated inflammation biomarkers associated with Cerebrovascular Disease (CVD), namely, ischemic Stroke (IS), Intracerebral Hemorrhage (ICH) and Cerebral Venous Thrombosis (CVT). As of today, neutrophil–lymphocyte ratio (NLR) seems the be the most widely studied and accepted biomarker for cerebrovascular disease due to its easy access and availability. Although demonstrated as a prognostic risk factor, in IS, ICH and CVT, its diagnostic role is still under investigation. Several other prognostic factors could be used or even combined together into a diagnostic or prognostic index. Multiple inflammatory biomarkers appear to be involved in IS, ICH, and CVT. Blood inflammatory cells, easily measured and accessible at admission may provide information regarding accurate diagnosis and prognosis. Although not yet a reality, increasing evidence exists to suggest that these may become potential therapeutic targets, likely influencing or mitigating complications of CVD and improving prognosis. Nevertheless, further larger, well-designed randomized clinical trials are still needed to follow up this hypothesis.
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22
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Li W, Hou M, Ding Z, Liu X, Shao Y, Li X. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:686983. [PMID: 34630275 PMCID: PMC8497704 DOI: 10.3389/fneur.2021.686983] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Stroke has become a major problem around the world, which is one of the main causes of long-term disability. Therefore, it is important to seek a biomarker to predict the prognosis of patients with stroke. This meta-analysis aims to clarify the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the prognosis of stroke patients. Methods: This study was pre-registered in PROSPERO (CRD42020186544). We performed systematic research in PubMed, Web of Science, and EMBASE databases for studies investigating the prognostic value of NLR. Based on the enrolled studies, patients were divided into the low-NLR cohort and the high-NLR cohort. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted and analyzed by the Review Manager 5.3 and Stata 12.0 software. Heterogeneity was estimated by using Cochran's Q test and I2 value. Sensitivity analyses and subgroup analyses were also performed to explore the potential sources of heterogeneity. Publication bias was assessed with funnel plots and assessed by Egger's tests. Results: Forty-one studies with 27,124 patients were included. In the overall analysis, elevated NLR was associated with an increased mortality in acute ischemic stroke (AIS) patients (OR = 1.12, 95% CI = 1.07–1.16) and in acute hemorrhagic stroke (AHS) patients (OR = 1.23, 95% CI = 1.09–1.39), poorer outcomes in AIS patients (OR = 1.29, 95% CI = 1.16–1.44), and in AHS patients (OR = 1.11, 95% CI = 1.03–1.20). While in terms of hemorrhagic transformation (HT), elevated NLR was associated with an increased incidence of HT in AIS patients (OR = 1.15, 95% CI = 1.08–1.23). Conclusions: This study demonstrated that elevated NLR was significantly associated with poor prognosis of stroke patients. High NLR is associated with a 1.1- to 1.3-fold increased risk of poor outcomes of AIS/AHS patients. NLR could be helpful as a potential prognostic biomarker to guide clinical decision making. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186544.
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Affiliation(s)
- Wenxia Li
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Miaomiao Hou
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhibin Ding
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaolei Liu
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuan Shao
- Shanxi Medical University, Taiyuan, China
| | - Xinyi Li
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.,Shanxi Medical University, Taiyuan, China
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23
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Li Y, Wen D, Cui W, Chen Y, Zhang F, Yuan M, Xiao H, Li H, Ma L, Hu X, You C. The Prognostic Value of the Acute Phase Systemic Immune-Inflammation Index in Patients With Intracerebral Hemorrhage. Front Neurol 2021; 12:628557. [PMID: 34113303 PMCID: PMC8185273 DOI: 10.3389/fneur.2021.628557] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/30/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose: The systemic immune–inflammation index (SII) is a novel prognostic index in various diseases. We evaluated the predictive value of SII in patients with intracerebral hemorrhage (ICH). Methods: Patients with primary spontaneous ICH were enrolled. SII was constructed based on peripheral platelet (P), neutrophil (N), and lymphocyte (L) and defined as P*N/L. In addition to admission testing, acute phase SII was collected to analyze the potential dynamic change. Poor outcome was defined as modified Rankin Scale of more than 3 at 90 days. Results: We included 291 patients; 98 (34%) achieved favorable functional outcomes. Day-1 SII was higher and was more related to poor outcome than was admission SII. Median time of day-1 SII was 29 h from onset. Day-1 SII had an OR in outcome (mRS >3) 1.74 (95% CI = 1.03–3.00, p = 0.04). The binary cutoff point of SII calculated using the area under the curve (AUC) method was 1,700 × 109/L, AUC 0.699 (95% CI = 0.627–0.774) (sensitivity 53.3%, specificity 77.3%) (OR = 2.36, 95% CI = 1.09–5.26, p = 0.03). Conclusions: SII, especially day-1 SII, was highly associated with 90-day functional outcome in patients with ICH and could be used to predict outcomes.
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Affiliation(s)
- Yunke Li
- Neurosurgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Dingke Wen
- Neurosurgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Wenyao Cui
- Neurosurgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Chen
- Neurosurgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Fazhen Zhang
- Medical School of Sichuan University, Chengdu, China
| | - Maolin Yuan
- Medical School of Sichuan University, Chengdu, China
| | - Han Xiao
- Medical School of Sichuan University, Chengdu, China
| | - Hao Li
- Neurosurgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Lu Ma
- Neurosurgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Xin Hu
- Neurosurgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Neurosurgery Department of West China Hospital, Sichuan University, Chengdu, China
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24
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Chong L, Han L, Liu R, Ma G, Ren H. Association of Lymphocyte-to-Monocyte Ratio with Poststroke Depression in Patients with Acute Ischemic Stroke. Med Sci Monit 2021; 27:e930076. [PMID: 34021110 PMCID: PMC8152443 DOI: 10.12659/msm.930076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Poststroke depression (PSD) is a common neuropsychiatric disorder after stroke. The neuroinflammatory response exerts a vital effect in the development of PSD. Lymphocyte-to-monocyte ratio (LMR), a systemic inflammation biomarker, is associated with poor prognosis of acute ischemic stroke (AIS). The purpose of this study was to determine the association between LMR and PSD at 3 months. Material/Methods AIS patients (507) were included in this study. Patients were categorized into 3 tertiles and each tertile contains 169 patients: tertile1 (>4.85), tertile 2 (2.96 to 4.85), and tertile 3 (<2.96), based on LMR values and the numbers of patients. PSD was diagnosed with a 17-item Hamilton Depression Scale score of 8 or higher. Results Patients (141; 27.8%) were diagnosed with PSD at 3-month follow-up. Patients in the PSD group presented with more severe stroke and lower LMR values (P<0.001). Decreased LMRs were independently associated with occurrence of PSD (middle tertile: odds ratio [OR] 1.823, P=0.037; lowest tertile: OR 3.024, P<0.001). A significant association of a lower LMR value with PSD severity was found (middle tertile: OR 1.883, P=0.031; lowest tertile: OR 2.633, P=0.001). The receiver operating characteristic curve indicates that the optimal threshold of LMR as a predictor for PSD was 3.14, which yielded a sensitivity of 72.4% and a specificity of 68.1%. Conclusions Decreased LMR is independently associated with PSD and increased PSD severity.
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Affiliation(s)
- Lining Chong
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Lin Han
- Department of Neurology, Hengshui Hospital of Traditional Chinese Medicine, Hengshui, Hebei, China (mainland)
| | - Ruqian Liu
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Guomei Ma
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Hao Ren
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
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25
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Wu XY, Zhuang YK, Cai Y, Dong XQ, Wang KY, Du Q, Yu WH. Serum glucose and potassium ratio as a predictive factor for prognosis of acute intracerebral hemorrhage. J Int Med Res 2021; 49:3000605211009689. [PMID: 33906531 PMCID: PMC8108090 DOI: 10.1177/03000605211009689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective The serum glucose/potassium ratio (GPR) is a potential prognostic predictor for acute brain injury-related diseases. We calculated the serum GPR in patients with acute intracerebral hemorrhage (ICH) and explored its prognostic value for long-term prognoses and ICH severity. Methods This retrospective cohort study consecutively included 92 patients with ICH and 92 healthy controls. The National Institutes of Health Stroke Scale (NIHSS) score, Glasgow coma scale (GCS) score, and hematoma volume were used to assess severity. A modified Rankin Scale score > 2 at 90 days post-stroke was defined as a poor outcome. Results The serum GPR was significantly higher in patients than controls. The serum GPR was weakly correlated with the NIHSS score, GCS score, and hematoma volume. The serum GPR, GCS score, and hematoma volume were independently associated with poor outcomes. In the receiver operating characteristic curve analysis, the serum GPR remarkably discriminated patients at risk of poor outcomes at 90 days. The serum GPR significantly improved the prognostic predictive capability of hematoma volume and tended to increase that of the GCS score. Conclusion Serum GPR is an easily obtained clinical variable for predicting clinical outcomes after ICH.
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Affiliation(s)
- Xiao-Yu Wu
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yao-Kun Zhuang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yong Cai
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao-Qiao Dong
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ke-Yi Wang
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quan Du
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen-Hua Yu
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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26
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Yang Y, Sun G, Diao S, Yang L, Dong W. Diagnostic performances of neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio in acute ischemic stroke caused by cervicocranial arterial dissection. J Clin Lab Anal 2020; 34:e23515. [PMID: 32893925 PMCID: PMC7755785 DOI: 10.1002/jcla.23515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Inflammation plays an important role in the initiation and progression of cervicocranial arterial dissection (CCAD). New inflammatory indices derived from full cell blood count may be associated with increased risk of acute ischemic stroke (AIS) caused by CCAD. The goal of this study is to evaluate the diagnostic performances of neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR) in CCAD. METHOD We retrospectively analyzed 52 patients with AIS caused by CCAD from emergency room (group I), 51 patients with CCAD from emergency room or clinic(group II) and 52 controls (group III), age and sex matched. Data were collected on the admission including NLR and LMR. RESULTS Neutrophil to lymphocyte ratio and LMR have significant differences among three groups, especially in group I vs both groups II and III (P < .001). There was a negative correlation between admission NLR and LMR. Low LMR level and high NLR level may be associated with severity of AIS caused by CCAD and significantly predict AIS in CCAD. The area under the curve of NLR and LMR were 0.77 and 0.71, respectively, on receiver operating characteristic curve analysis. The optimal cutoff values of NLR and LMR that best discriminated AIS were 2.35 (81% sensitivity and 63% specificity) and 3.67 (64% sensitivity and 77% specificity). CONCLUSIONS Neutrophil to lymphocyte ratio neutrophil to lymphocyte ratio and LMR may contribute to the diagnostic evaluation and prompt immediate therapy in patients with CCAD.
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Affiliation(s)
- Yi Yang
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Guangbi Sun
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Shanshan Diao
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Le Yang
- School of Public HealthFujian Medical UniversityFuzhouChina
| | - Wanli Dong
- Departments of NeurologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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27
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Ao G, Wang Y, Qi X, Wang F, Wen H. Association of neutrophil-to-lymphocyte ratio and risk of cardiovascular or all-cause mortality in chronic kidney disease: a meta-analysis. Clin Exp Nephrol 2020; 25:157-165. [PMID: 33025234 DOI: 10.1007/s10157-020-01975-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND It is currently controversial whether neutrophil-to-lymphocyte ratio (NLR) has a prognostic role in patients with chronic kidney disease (CKD). We aimed to investigate whether NLR was an independent predictor of cardiovascular or all-cause mortality in CKD patients with or without hemodialysis by performing a meta-analysis. METHODS Pubmed, Embase, and Cochrane Library databases are systematically searched for relevant literature that investigated NLR and subsequent cardiovascular or all-cause mortality risk in CKD with or without dialysis. Pooled hazard risk (HR) with 95% confidence interval (CI) was calculated for the high vs. low NLR category. RESULTS A total of thirteen studies enrolling 116,709 patients were identified and analyzed. In summary, high NLR was associated with an increased risk of all-cause mortality (HR 1.93, 95% CI 1.87-2.00; P < 0.00001) and cardiovascular mortality (HR 1.45, 95% CI 1.18-1.79, P < 0.001). Subgroup analysis indicated that high NLR are independently associated with all-cause mortality risk in dialysis patients (HR 1.94, 95% CI 1.87-2.01; P < 0.00001). CONCLUSIONS This meta-analysis indicates a high NLR is related to all-cause mortality and cardiovascular mortality in patients with chronic kidney disease. Dialysis patients with high NLR are candidates at high risk of mortality to allow for earlier interventions. Further large scale and more rigorously designed studies are warranted to confirm the prognostic value of NLR in the different stages of CKD.
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Affiliation(s)
- Guangyu Ao
- Department of Nephrology, Chengdu First People's Hospital, No.18 North Wanxiang Road, High-tech District, Chengdu, 610016, Sichuan, China
| | - Yushu Wang
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Xin Qi
- Department of Neurology, Chengdu Third People's Hospital, Chengdu, Sichuan, China
| | - Fengping Wang
- Department of Nephrology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Huitao Wen
- Department of Nephrology, Chengdu First People's Hospital, No.18 North Wanxiang Road, High-tech District, Chengdu, 610016, Sichuan, China.
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28
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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: 9.6] [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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29
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Lymphocyte-to-monocyte ratio and risk of hemorrhagic transformation in patients with acute ischemic stroke. Neurol Sci 2020; 41:2511-2520. [DOI: 10.1007/s10072-020-04355-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/16/2020] [Indexed: 02/08/2023]
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30
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Arellano-Orden E, Bacopoulou F, Baicus C, Bonfrate L, Broadbent J, Buechler C, Carbone F, Charmandari E, Davis GR, Dullaart RPF, Efthymiou V, Goeser F, Goswami N, Jong GP, Lichtenauer M, Liou YS, Lutz P, Maeng M, Mert GÖ, Mert KU, Montecucco F, Ndrepepa G, Olesen KKW, Oliveira P, Perton FG, Portincasa P, Rodriguez-Panadero F, Schernthaner C, Schutte R. Research update for articles published in EJCI in 2017. Eur J Clin Invest 2019; 49:e13163. [PMID: 31524285 DOI: 10.1111/eci.13163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Elena Arellano-Orden
- Medical-Surgical Unit of Respiratory Diseases, University Hospital Virgen del Rocio, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), Seville, Spain.,Center for Biomedical Research in Respiratory Diseases Network, Carlos III Health Institute, Madrid, Spain
| | - Flora Bacopoulou
- First Department of Pediatrics, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Cristian Baicus
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Leonilde Bonfrate
- Department of Biomedical Sciences & Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - James Broadbent
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Christa Buechler
- Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.,Division of Endocrinology and Metabolism, Clinical, Experimental Surgery and Translational Research Center, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Greggory R Davis
- Red Lerille's/LEQSF Regents Endowed Professor in Health and Physical Education, University of Louisiana at Lafayette, Lafayette, LA, USA
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vasiliki Efthymiou
- First Department of Pediatrics, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Felix Goeser
- Department of Internal Medicine I, University of Bonn, Bonn, German.,German Center for Infection Research, Bonn, Germany
| | - Nandu Goswami
- Physiology Division, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - Gwo-Ping Jong
- Division of Internal Cardiology, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan ROC
| | | | - Yi-Sheng Liou
- Department of Family Medicine, Taichung Veteran General Hospital, Taichung, ROC.,School of Public Health, National Defense Medical Center, Taipei, Taiwan ROC
| | - Philipp Lutz
- Department of Internal Medicine I, University of Bonn, Bonn, German.,German Center for Infection Research, Bonn, Germany
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Gurbet Özge Mert
- Department of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | | | | | - Paulo Oliveira
- CNC - Center for Neuroscience and Cell Biology, UC-Biotech, University of Coimbra, Cantanhede, Portugal
| | - Frank G Perton
- Laboratory Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Piero Portincasa
- Department of Biomedical Sciences & Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - Francisco Rodriguez-Panadero
- Medical-Surgical Unit of Respiratory Diseases, University Hospital Virgen del Rocio, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | | | - Rudolph Schutte
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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