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Jamali SA, Turnbull MT, Kanekiyo T, Vishnu P, Zubair AC, Raper CC, Tawk RG, Freeman WD. Elevated Neutrophil-Lymphocyte Ratio is Predictive of Poor Outcomes Following Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:104631. [PMID: 31964576 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104631] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/22/2019] [Indexed: 02/09/2023] Open
Abstract
Background Recent studies of patients with intracerebral hemorrhage suggest an association between peripheral blood neutrophil-lymphocyte ratio and neurologic deterioration. We aimed to study the prognostic utility of neutrophil-lymphocyte ratio in predicting inpatient mortality in aneurysmal subarachnoid hemorrhage. Methods We conducted a retrospective electronic medical record review of the clinical, laboratory, and radiographic data of patients with aneurysmal subarachnoid hemorrhage 18 years of age or older presenting to the neuroscience intensive care unit from January 1, 2011, to December 31, 2017. Patients with aneurysmal subarachnoid hemorrhage were divided into 2 groups (group 1, alive at discharge; group 2, deceased prior to discharge), and neutrophil-lymphocyte ratio laboratory mean values were recorded for each patient. Our primary outcome measure was inpatient mortality, and our secondary measure was incidence of pneumonia with hospitalization. Results We identified 403 patients with aneurysmal subarachnoid hemorrhage for the study. After exclusion criteria, 44 eligible patients were divided into the 2 groups (group 1, n = 32; group 2, n = 12). Mean neutrophil-lymphocyte ratio for group 1 was 11.53, and for group 2, 17.85 (P < .01). The mean neutrophil-lymphocyte ratio of those who developed pneumonia compared to those who did not was 15.28 versus 12.81, respectively (P = .39). A Kaplan-Meier plot demonstrated increased mortality among patients with a neutrophil-lymphocyte ratio equal to or greater than 12.5 compared to those with a neutrophil-lymphocyte ratio less than 12.5. Conclusions These preliminary data demonstrate that a neutrophil-lymphocyte ratio equal to or greater than 12.5 at admission predict higher inpatient mortality in patients with aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
| | | | | | - Prakash Vishnu
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Abba C Zubair
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, Florida
| | - Carol C Raper
- Quality Management Services, Mayo Clinic, Jacksonville, Florida
| | - Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida; Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - William D Freeman
- Department of Neurology, Mayo Clinic, Jacksonville, Florida; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida; Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida.
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Goldstein ED, Schnusenberg L, Mooney L, Raper CC, McDaniel S, Thorpe DA, Franke MT, Anderson LK, McClure LL, Oglesby MM, Lewis CY, Velichko C, Bradley BG, Horn WW, Reid AN, Siegel JL, Cannistraro R, Bechtle P, Barbosa MT, Silvers SM, Brown BL, Freeman WD, Miller DA, Barrett KM, Huang JF. Reducing Door-to-Reperfusion Time for Mechanical Thrombectomy With a Multitiered Notification System for Acute Ischemic Stroke. Mayo Clin Proc Innov Qual Outcomes 2018; 2:119-128. [PMID: 30225442 PMCID: PMC6124324 DOI: 10.1016/j.mayocpiqo.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To reduce door-to-angiographic reperfusion (DTR) time to 120 minutes for patients presenting with acute ischemic stroke attributed to anterior circulation large-vessel occlusion amenable to endovascular mechanical thrombectomy. PATIENTS AND METHODS Patients treated with mechanical thrombectomy before (April 10, 2015, through April 11, 2016) and after (April 12, 2016, through May 10, 2017) implementation of a multitiered notification system were studied. Lean process mapping was used to assess inefficiencies with multidisciplinary triage. A 3-tiered paging platform, which rapidly alerts essential personnel of the acute ischemic stroke team at advancing decision points, was introduced. RESULTS Sixty-two patients were analyzed before and after implementation (34 vs 28, respectively). Following intervention, DTR time was reduced by 43 minutes (mean DTR, 170 minutes vs 127 minutes; P=.02). At 90-day follow up, 5 of the 28 patients in the postintervention cohort (19%) had excellent neurologic outcomes, defined as a modified Rankin Scale score of 0, compared to 0 of 34 (0%) in the preintervention cohort (P=.89). Reductions were also seen in the length of stay on the neurocritical care service (mean, 6 vs 3 days; P=.006), and total hospital charges for combined groups (mean, $100,083 vs $161,458; P<.001). CONCLUSION The multitiered notification system was a feasible solution for improving DTR within our institution, resulting in reductions of overall DTR time, neurocritical care service length of stay, and total hospital charges.
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Key Words
- AIS, acute ischemic stroke
- ASPECTS, Alberta Stroke Program Early CT Score
- CT, computed tomography
- DTR, door-to-angiographic reperfusion
- ED, emergency department
- IV, intravenous
- LTR, last known normal time to angiographic reperfusion
- LVO, large-vessel occlusion
- MT, mechanical thrombectomy
- NCC, neurocritical care service
- NIHSS, National Institutes of Health Stroke Scale
- mRS, modified Rankin Scale
- rtPA, human recombinant tissue plasminogen activator
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Affiliation(s)
- Eric D. Goldstein
- Department of Neurology, Mayo Clinic, Jacksonville, FL
- Correspondence: Address to Eric D. Goldstein, MD, Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224.
| | - Lynda Schnusenberg
- Department of Management Engineering and Internal Consulting, Mayo Clinic, Jacksonville, FL
| | - Lesia Mooney
- Department of Neurology, Mayo Clinic, Jacksonville, FL
- Department of Nursing, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | | | | | - Cammi Velichko
- Department of Neurology, Mayo Clinic, Jacksonville, FL
- Department of Nursing, Mayo Clinic, Jacksonville, FL
| | | | - William W. Horn
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | | | - Jason L. Siegel
- Department of Neurology, Mayo Clinic, Jacksonville, FL
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Perry Bechtle
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL
| | | | | | | | - William D. Freeman
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL
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