Early Neutrophil Count Relates to Infarct Size and Fatal Outcome After Large Hemispheric Infarction

Overview

Journal CNS Neurosci Ther

Specialties Neurology
Pharmacology

Date 2020 May 7

PMID 32374521

Citations 18

Authors

Li-Li Cui

Yan Zhang

Zhong-Yun Chen

Ying-Ying Su

Yawu Liu

Johannes Boltze

Affiliations

Soon will be listed here.

Abstract

Aims: To investigate the relationship between peripheral leukocyte dynamics and the outcome of large hemispheric infarction (LHI) patients.

Methods: Patients with acute LHI admitted to the neuro-intensive care unit of Xuanwu Hospital from 2013 to 2017 were prospectively enrolled and followed up for 6 months after LHI.

Results: A total of 84 LHI patients were included, 38 patients suffered brain herniation and 20 patients died from stroke. Compared to patients with benign course, LHI patients with fatal outcome showed larger infarcts and more severe brain edema (P < .01), as well as increased WBC and neutrophil counts throughout the first week after stroke (P < .05). Correlation analysis revealed that neutrophil counts on D2 after LHI positively correlated with infarct and edema volumes measured from CT/MRI (R = 0.22 and R = 0.15, P < .01) and negatively correlated with Glasgow Coma Scale (ρ = -0.234, P < .05). Patients with D2 neutrophils > 7.14 × 10 /L had higher risk of brain herniation [odds ratio (OR) = 7.5, 95% CI: 2.0-28.1, P = .001], and patients with D2 neutrophils > 7.79 × 10 /L had a higher risk of death (OR = 5.8, 95% CI: 1.2-27.0, P = .015).

Conclusion: Early peripheral neutrophil count after stroke relates to infarct size and the fatal outcome of LHI patients, which might help guiding acute LHI management such as reduction of intracranial pressure and potential antiinflammatory therapy in the future.

Citing Articles

The value of electroencephalography features in the prognostic evaluation of large hemispheric infarction patients at different time intervals.

Jing X, Zhou X, Zan Z, Luo J, Li F, Zhang H Neurol Sci. 2024; 46(2):791-800.

PMID: 39382625 DOI: 10.1007/s10072-024-07785-1.

Validation and refinement of a predictive nomogram using artificial intelligence: assessing in-hospital mortality in patients with large hemispheric cerebral infarction.

Ding J, Ma X, Huang W, Yue C, Xu G, Wang Y Front Neurol. 2024; 15:1398142.

PMID: 38984035 PMC: 11231922. DOI: 10.3389/fneur.2024.1398142.

Effects of peripheral blood cells on ischemic stroke: Greater immune response or systemic inflammation?.

Gong H, Li Z, Huang G, Mo X Heliyon. 2024; 10(11):e32171.

PMID: 38868036 PMC: 11168442. DOI: 10.1016/j.heliyon.2024.e32171.

Predicting Futile Recanalization in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy: The Role of White Blood Cell Count to Mean Platelet Volume Ratio.

Yu W, Jia M, Guo W, Xu J, Ren C, Li S Curr Neurovasc Res. 2023; 21(1):6-14.

PMID: 38141190 DOI: 10.2174/0115672026288143231212051101.

Perspective from single-cell sequencing: Is inflammation in acute ischemic stroke beneficial or detrimental?.

Deng X, Hu Z, Zhou S, Wu Y, Fu M, Zhou C CNS Neurosci Ther. 2023; 30(1):e14510.

PMID: 37905592 PMC: 10805403. DOI: 10.1111/cns.14510.

References

Cui L, Zhang Y, Chen Z, Su Y, Liu Y, Boltze J . Early neutrophil count relates to infarct size and fatal outcome after large hemispheric infarction. CNS Neurosci Ther. 2020; 26(8):829-836. PMC: 7366744. DOI: 10.1111/cns.13381. View

Kalra L, Irshad S, Hodsoll J, Simpson M, Gulliford M, Smithard D . Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial. Lancet. 2015; 386(10006):1835-44. DOI: 10.1016/S0140-6736(15)00126-9. View

Price C, Menon D, Peters A, Ballinger J, Barber R, Balan K . Cerebral neutrophil recruitment, histology, and outcome in acute ischemic stroke: an imaging-based study. Stroke. 2004; 35(7):1659-64. DOI: 10.1161/01.STR.0000130592.71028.92. View

Dohmen C, Bosche B, Graf R, Staub F, Kracht L, Sobesky J . Prediction of malignant course in MCA infarction by PET and microdialysis. Stroke. 2003; 34(9):2152-8. DOI: 10.1161/01.STR.0000083624.74929.32. View

Zhao J, Ying Su Y, Zhang Y, Zhang Y, Zhao R, Wang L . Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old. Neurocrit Care. 2012; 17(2):161-71. DOI: 10.1007/s12028-012-9703-3. View

Thomalla G, Hartmann F, Juettler E, Singer O, Lehnhardt F, Kohrmann M . Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational study. Ann Neurol. 2010; 68(4):435-45. DOI: 10.1002/ana.22125. View

Frank J . Large hemispheric infarction, deterioration, and intracranial pressure. Neurology. 1995; 45(7):1286-90. DOI: 10.1212/wnl.45.7.1286. View

Torbey M, Bosel J, Rhoney D, Rincon F, Staykov D, Amar A . Evidence-based guidelines for the management of large hemispheric infarction : a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine. Neurocrit Care. 2015; 22(1):146-64. DOI: 10.1007/s12028-014-0085-6. View

Jickling G, Liu D, Ander B, Stamova B, Zhan X, Sharp F . Targeting neutrophils in ischemic stroke: translational insights from experimental studies. J Cereb Blood Flow Metab. 2015; 35(6):888-901. PMC: 4640255. DOI: 10.1038/jcbfm.2015.45. View

10.

Moller K, Boltze J, Posel C, Seeger J, Stahl T, Wagner D . Sterile inflammation after permanent distal MCA occlusion in hypertensive rats. J Cereb Blood Flow Metab. 2013; 34(2):307-15. PMC: 3915208. DOI: 10.1038/jcbfm.2013.199. View

11.

Frieler R, Chung Y, Ahlers C, Gheordunescu G, Song J, Vigil T . Genetic neutrophil deficiency ameliorates cerebral ischemia-reperfusion injury. Exp Neurol. 2017; 298(Pt A):104-111. PMC: 5658240. DOI: 10.1016/j.expneurol.2017.08.016. View

12.

Juttler E, Unterberg A, Woitzik J, Bosel J, Amiri H, Sakowitz O . Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014; 370(12):1091-100. DOI: 10.1056/NEJMoa1311367. View

13.

Gerriets T, Stolz E, Walberer M, Muller C, Kluge A, Bachmann A . Noninvasive quantification of brain edema and the space-occupying effect in rat stroke models using magnetic resonance imaging. Stroke. 2004; 35(2):566-71. DOI: 10.1161/01.STR.0000113692.38574.57. View

14.

Chu H, Kim H, Lee S, Moore J, Chan C, Vinh A . Immune cell infiltration in malignant middle cerebral artery infarction: comparison with transient cerebral ischemia. J Cereb Blood Flow Metab. 2013; 34(3):450-9. PMC: 3948121. DOI: 10.1038/jcbfm.2013.217. View

15.

Zhang Y, Liu G, Wang Y, Su Y, Leak R, Cao G . Procalcitonin as a Biomarker for Malignant Cerebral Edema in Massive Cerebral Infarction. Sci Rep. 2018; 8(1):993. PMC: 5772664. DOI: 10.1038/s41598-018-19267-4. View

16.

Haupt W, Chopan G, Sobesky J, Liu W, Dohmen C . Prognostic value of somatosensory evoked potentials, neuron-specific enolase, and S100 for short-term outcome in ischemic stroke. J Neurophysiol. 2016; 115(3):1273-8. PMC: 4808083. DOI: 10.1152/jn.01012.2015. View

17.

Jauch E, Saver J, Adams Jr H, Bruno A, Connors J, Demaerschalk B . Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(3):870-947. DOI: 10.1161/STR.0b013e318284056a. View

18.

Iadecola C, Anrather J . The immunology of stroke: from mechanisms to translation. Nat Med. 2011; 17(7):796-808. PMC: 3137275. DOI: 10.1038/nm.2399. View

19.

Hermann D, Kleinschnitz C, Gunzer M . Implications of polymorphonuclear neutrophils for ischemic stroke and intracerebral hemorrhage: Predictive value, pathophysiological consequences and utility as therapeutic target. J Neuroimmunol. 2018; 321:138-143. DOI: 10.1016/j.jneuroim.2018.04.015. View

20.

Goyal N, Tsivgoulis G, Chang J, Malhotra K, Pandhi A, Ishfaq M . Admission Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker of Outcomes in Large Vessel Occlusion Strokes. Stroke. 2018; 49(8):1985-1987. DOI: 10.1161/STROKEAHA.118.021477. View