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Akut intraserebral hemorajide platelet-albumin-bilirubin ve sistemik immun inflamatuar indekslerin değerlendirilmesi

Year 2022, Volume: 1 Issue: 3, 142 - 151, 23.12.2022

Abstract

Amaç: Biz bu çalışmada intraserebral hemoraji (İSH) hastalarında yeni inflamatuar göstergeler olan sistemik immun-inflamatuar indeks (Sİİ) ile platelet-albumin-bilirübin indeksi (PALBİ) ölçmeyi ve bu değerlerin hastalıkla ilişkisi ile İSH’nin kısa dönem prognozu üzerindeki etkisini ortaya koymayı hedefledik.
Materyal ve Metod: Retrospektif çalışmamıza İSH tanısı almış 245 hasta ile 250 sağlıklı gönüllü dahil edildi.
Bulgular: Sağlıklı gönüllülerle karşılaştırıldığında, İSH hastaları daha düşük PALBİ (p=0.028) ve daha yüksek Sİİ değerlerine (p<0.01) sahipti. Ayrıca mRS (modifiye Rankin skalası) ve NIHSS (National Institutes of Health Stroke Scale)'ye göre hem yatışta hem de 30 gün sonunda prognozu kötü ve şiddetli İSH olan hasta grubunda Sİİ oranı daha yüksek iken, PALBİ oranı daha düşüktü. 245 İSH hastasının 45'i 30 gün içinde ex olmuştu. Benzer şekilde, exitus olan grupta Sİİ değeri, hayatta kalan gruba göre istatistiksel olarak anlamlı derecede yüksek (p<0.01), PALBİ değeri ise daha düşüktü (p<0.01). Çok değişkenli lojistik regresyon analizi, başvuru sırasındaki Sİİ ve PALBİ değerlerinin İSH'den sonraki 30 gün içinde mortalitenin bağımsız öngörücüleri olduğunu ortaya koydu. Alıcı çalışma karakteristik eğrileri, Sİİ değeri için 1098.12'nin ve PALBİ değeri için -4.11'in İSH sonrası 30 günlük mortaliteyi tahmin etmek için optimal eşik değerler olduğunu gösterdi.
Sonuç: İSH hastalarında erken dönemde bakılan Sİİ ve PALBİ indeksleri, İSH hastalarının hem akut dönemde hem de 30 günlük ciddiyeti ve prognozu ile yakından ilişkilidir. Ayrıca, İSH sonrası 30 günlük mortaliteyi tahmin etmek için bağımsız öngörücü belirteçler olarak da kullanılabilirler.

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References

  • Clark, J.F., Loftspring, M., Wurster, W.L., Beiler, S., Beiler, C., Wagner, K.R. & Pyne-Geithman, G.J. (2008). Bilirubin oxidation products, oxidative stress, and intracerebral hemorrhage. In Cerebral Hemorrhage (pp. 7-12). Springer, Vienna.
  • Farrera, J.A., Jaumà, A., Ribó, J.M., Peiré, M.A., Parellada, P.P., Roques-Choua, S., ... & Seta, P. (1994). The antioxidant role of bile pigments evaluated by chemical tests. Bioorganic & Medicinal Chemistry, 2(3), 181-185.
  • Fernandes, A., Vaz, A.R., Falcao, A.S., Silva, R. F., Brito, M.A. & Brites, D. (2007). Glycoursodeoxycholic acid and interleukin-10 modulate the reactivity of rat cortical astrocytes to unconjugated bilirubin. Journal of Neuropathology & Experimental Neurology, 66(9), 789-798.
  • Gopal, D.M., Kalogeropoulos, A.P., Georgiopoulou, V. V., Tang, W.W., Methvin, A., Smith, A.L., ... & Butler, J. (2010). Serum albumin concentration and heart failure risk: the health, aging, and body composition study. American Heart Journal, 160(2), 279-285.
  • Gordo, A.C., Falcao, A.S., Fernandes, A., Brito, M.A., Silva, R.F. & Brites, D. (2006). Unconjugated bilirubin activates and damages microglia. Journal of Neuroscience Research, 84(1), 194-201.
  • Hou, D., Wang, C., Luo, Y., Ye, X., Han, X., Feng, Y., ... & Wu, D. (2021). Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). International Journal of Neuroscience,131(12), 1203-1208.
  • Hu, B., Yang, X.R., Xu, Y., Sun, Y.F., Sun, C., Guo, W., ... & Fan, J. (2014). Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clinical Cancer Research, 20(23), 6212-6222.
  • Hua, Y., Xi, G., Keep, R.F., & Hoff, J.T. (2000). Complement activation in the brain after experimental intracerebral hemorrhage. Journal of Neurosurgery,92(6), 1016-1022.
  • Huang, F.P., Xi, G., Keep, R.F., Hua, Y., Nemoianu, A. & Hoff, J. T. (2002). Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products. Journal of Neurosurgery,96(2), 287-293.
  • Johnson, C.O., Nguyen, M., Roth, G.A., Nichols, E., Alam, T., Abate, D., ... & Miller, T.R. (2019). Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the global burden of disease study 2016. The Lancet Neurology,18(5), 439-458.
  • Johnson, P.J., Berhane, S., Kagebayashi, C., Satomura, S., Teng, M., Reeves, H.L., ... & Toyoda, H. (2015). Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—the ALBI grade. Journal of Clinical Oncology, 33(6), 550.
  • Kaustubh L., Yang J.D., Hinduja A. (2016). Role of admission serum albumin levels in patients with intracerebral hemorrhage. Acta Neurol Belg., 116(1), 27-30.
  • Keep, R.F., Hua, Y. & Xi, G. (2012). Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. The Lancet Neurology, 11(8), 720-731.
  • Lattanzi, S., Brigo, F., Trinka, E., Cagnetti, C., Di Napoli, M. & Silvestrini, M. (2019). Neutrophil-to-lymphocyte ratio in acute cerebral hemorrhage: a system review. Translational Stroke Research, 10(2), 137-145.
  • Leira, R.M.D.P., Davalos, A.M.D.P., Silva, Y., Gil-Peralta, A.M.D.P., Tejada, J.M.D.P., Garcia, M.M.D.P. & Castillo, J. (2004). Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology, 63(3), 461-467.
  • Li, Y., Wen, D., Cui, W., Chen, Y., Zhang, F., Yuan, M., ... & You, C. (2021). The prognostic value of the acute phase systemic ımmune–ınflammation ındex in patients with ıntracerebral hemorrhage. Frontiers in Neurology, 12, 628557.
  • Limaye, K., Yang, J.D. & Hinduja, A. (2016). Role of admission serum albumin levels in patients with intracerebral hemorrhage. Acta Neurologica Belgica, 116(1), 27-30.
  • Loftspring, M.C., Johnson, H., Feng, R., Johnson, A.J. & Clark, J.F. (2011). Unconjugated bilirubin contributes to early inflammation and edema after intracerebral hemorrhage. Journal of Cerebral Blood Flow & Metabolism, 31(4), 1133-1142.
  • Loftspring, M.C., McDole, J., Lu, A., Clark, J.F. & Johnson, A.J. (2009). Intracerebral hemorrhage leads to infiltration of several leukocyte populations with concomitant pathophysiological changes. Journal of Cerebral Blood Flow & Metabolism, 29(1), 137-143.
  • Lu, L.H., Zhang, Y.F., Mu-Yan, C., Kan, A., Zhong, X.P., Mei, J., ... & Guo, R.P. (2019). Platelet-albumin-bilirubin grade: risk stratification of liver failure, prognosis after resection for hepatocellular carcinoma. Digestive and Liver Disease, 51(10), 1430-1437.
  • Mackenzie, J.M. & Clayton, J.A. (1999). Early cellular events in the penumbra of human spontaneous intracerebral hemorrhage. Journal of Stroke and Cerebrovascular Diseases,8(1), 1-8.
  • Morotti, A., Marini, S., Lena, U.K., Crawford, K., Schwab, K., Kourkoulis, C., ... & Goldstein, J.N. (2017). Significance of admission hypoalbuminemia in acute intracerebral hemorrhage. Journal of Neurology, 264(5), 905-911.
  • Mracsko, E., Javidi, E., Na, S.Y., Kahn, A., Liesz, A. & Veltkamp, R. (2014). Leukocyte invasion of the brain after experimental intracerebral hemorrhage in mice. Stroke, 45(7), 2107-2114.
  • Qi, H., Wang, D., Deng, X. & Pang, X. (2018). Lymphocyte-to-monocyte ratio is an independent predictor for neurological deterioration and 90-day mortality in spontaneous intracerebral hemorrhage. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 24, 9282.
  • Sansing, L.H., Harris, T.H., Kasner, S.E., Hunter, C.A. & Kariko, K. (2011). Neutrophil depletion diminishes monocyte infiltration and improves functional outcome after experimental intracerebral hemorrhage. In Intracerebral Hemorrhage Research (pp. 173-178). Springer, Vienna.
  • Sansing, L.H., Kaznatcheeva, E.A., Perkins, C.J., Komaroff, E., Gutman, F.B. & Newman, G.C. (2003). Edema after intracerebral hemorrhage: correlations with coagulation parameters and treatment. Journal of Neurosurgery, 98(5), 985-992.
  • Shao, Z., Tu, S. & Shao, A. (2019). Pathophysiological mechanisms and potential therapeutic targets in intracerebral hemorrhage. Frontiers in Pharmacology, 10, 1079.
  • Sims, J.R., Gharai, L.R., Schaefer, P.W., Vangel, M., Rosenthal, E.S., Lev, M.H. & Schwamm, L.H. (2009). ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology, 72(24), 2104-2110.
  • Thakkar, M., Edelenbos, J. & Doré, S. (2019). Bilirubin and ischemic stroke: rendering the current paradigm to better understand the protective effects of bilirubin. Molecular Neurobiology, 56(8), 5483-5496.
  • Trifan, G. & Testai, F. D. (2020). Systemic Immune-Inflammation (SII) index predicts poor outcome after spontaneous supratentorial intracerebral hemorrhage. Journal of Stroke and Cerebrovascular Diseases, 29(9), 105057.
  • Volbers, B., Giede-Jeppe, A., Gerner, S.T., Sembill, J.A., Kuramatsu, J.B., Lang, S., ... & Huttner, H.B. (2018). Peak perihemorrhagic edema correlates with functional outcome in intracerebral hemorrhage. Neurology, 90(12), e1005-e1012.
  • Wagner, K.R., Sharp, F.R., Ardizzone, T.D., Lu, A. & Clark, J.F. (2003). Heme and iron metabolism: role in cerebral hemorrhage. Journal of Cerebral Blood Flow & Metabolism, 23(6), 629-652.
  • Wang, J. (2010). Preclinical and clinical research on inflammation after intracerebral hemorrhage. Prog Neurobiology, 92 (4):463-477.
  • Yang, Y.L., Wu, C.H., Hsu, P.F., Chen, S.C., Huang, S.S., Chan, W.L., ... & Leu, H.B. (2020). Systemic immune‐inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. European Journal of Clinical Investigation, 50(5), e13230.
  • Zhang, W., & Shen, Y. (2018). Platelet-to-lymphocyte ratio as a new predictive index of neurological outcomes in patients with acute intracranial hemorrhage: A retrospective study. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 24, 4413.
  • Zhao, X., Ting, S.M., Sun, G., Roy-O’Reilly, M., Mobley, A. S., Bautista Garrido, J., ... & Aronowski, J. (2018). Beneficial role of neutrophils through function of lactoferrin after intracerebral hemorrhage. Stroke, 49(5), 1241-1247.
  • Zhou, Y., Wang, Y., Wang, J., Stetler, R.A. & Yang, Q. W. (2014). Inflammation in intracerebral hemorrhage: from mechanisms to clinical translation. Progress in Neurobiology, 115, 25-44.

Evaluation of platelet-albumin-bilirubin (PALBI) and systemic immune-inflammation (SII) indices in acute intracerebral hemorrhage

Year 2022, Volume: 1 Issue: 3, 142 - 151, 23.12.2022

Abstract

Background: We aimed to evaluate systemic immune-inflammation (SII) and platelet-albumin-bilirubin indices (PALBI), which are new inflammatory markers, in intracerebral hemorrhage (ICH) patients and reveal the relationship of these values with the disease and their effect on the short-term prognosis of ICH.
Materials and Methods: Our retrospective study included 245 patients who were diagnosed with ICH and 250 healthy volunteers.
Results: Compared to healthy volunteers, ICH patients had lower PALBI (p=0.028) and higher SII values (p<0.01). Additionlly while SII rate were higher, PALBI rate were lower in patient group with poor prognosis and severe ICH according to mRS (modified Rankin scale) and NIHSS (National Institutes of Health Stroke Scale) both at admission and at the end of 30 days. 45 of 245 patients died within 30 days. Similarly, the SII value in the group who died was statistically significantly higher than the survived group (p<0.01), while PALBI value was lower (p<0.01). Multivariate logistic regression analysis revealed that SII and PALBI values at admission were independent predictors of mortality within 30 days after ICH. Receiver operating characteristic curves showed that 1098.12 for the SII value and -4.11 for the PALBI value were optimal cut-off values to predict 30-day mortality after ICH.
Conclusions: The SII and PALBI indices, checked in early period in ICH patients, are closely related to the severity and prognosis of ICH patients both in the acute period and at the end of 30 days. Furthermore, they can be used as independent predictive markers to estimate 30-day mortality after ICH.

Project Number

Yok

References

  • Clark, J.F., Loftspring, M., Wurster, W.L., Beiler, S., Beiler, C., Wagner, K.R. & Pyne-Geithman, G.J. (2008). Bilirubin oxidation products, oxidative stress, and intracerebral hemorrhage. In Cerebral Hemorrhage (pp. 7-12). Springer, Vienna.
  • Farrera, J.A., Jaumà, A., Ribó, J.M., Peiré, M.A., Parellada, P.P., Roques-Choua, S., ... & Seta, P. (1994). The antioxidant role of bile pigments evaluated by chemical tests. Bioorganic & Medicinal Chemistry, 2(3), 181-185.
  • Fernandes, A., Vaz, A.R., Falcao, A.S., Silva, R. F., Brito, M.A. & Brites, D. (2007). Glycoursodeoxycholic acid and interleukin-10 modulate the reactivity of rat cortical astrocytes to unconjugated bilirubin. Journal of Neuropathology & Experimental Neurology, 66(9), 789-798.
  • Gopal, D.M., Kalogeropoulos, A.P., Georgiopoulou, V. V., Tang, W.W., Methvin, A., Smith, A.L., ... & Butler, J. (2010). Serum albumin concentration and heart failure risk: the health, aging, and body composition study. American Heart Journal, 160(2), 279-285.
  • Gordo, A.C., Falcao, A.S., Fernandes, A., Brito, M.A., Silva, R.F. & Brites, D. (2006). Unconjugated bilirubin activates and damages microglia. Journal of Neuroscience Research, 84(1), 194-201.
  • Hou, D., Wang, C., Luo, Y., Ye, X., Han, X., Feng, Y., ... & Wu, D. (2021). Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). International Journal of Neuroscience,131(12), 1203-1208.
  • Hu, B., Yang, X.R., Xu, Y., Sun, Y.F., Sun, C., Guo, W., ... & Fan, J. (2014). Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clinical Cancer Research, 20(23), 6212-6222.
  • Hua, Y., Xi, G., Keep, R.F., & Hoff, J.T. (2000). Complement activation in the brain after experimental intracerebral hemorrhage. Journal of Neurosurgery,92(6), 1016-1022.
  • Huang, F.P., Xi, G., Keep, R.F., Hua, Y., Nemoianu, A. & Hoff, J. T. (2002). Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products. Journal of Neurosurgery,96(2), 287-293.
  • Johnson, C.O., Nguyen, M., Roth, G.A., Nichols, E., Alam, T., Abate, D., ... & Miller, T.R. (2019). Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the global burden of disease study 2016. The Lancet Neurology,18(5), 439-458.
  • Johnson, P.J., Berhane, S., Kagebayashi, C., Satomura, S., Teng, M., Reeves, H.L., ... & Toyoda, H. (2015). Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—the ALBI grade. Journal of Clinical Oncology, 33(6), 550.
  • Kaustubh L., Yang J.D., Hinduja A. (2016). Role of admission serum albumin levels in patients with intracerebral hemorrhage. Acta Neurol Belg., 116(1), 27-30.
  • Keep, R.F., Hua, Y. & Xi, G. (2012). Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. The Lancet Neurology, 11(8), 720-731.
  • Lattanzi, S., Brigo, F., Trinka, E., Cagnetti, C., Di Napoli, M. & Silvestrini, M. (2019). Neutrophil-to-lymphocyte ratio in acute cerebral hemorrhage: a system review. Translational Stroke Research, 10(2), 137-145.
  • Leira, R.M.D.P., Davalos, A.M.D.P., Silva, Y., Gil-Peralta, A.M.D.P., Tejada, J.M.D.P., Garcia, M.M.D.P. & Castillo, J. (2004). Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology, 63(3), 461-467.
  • Li, Y., Wen, D., Cui, W., Chen, Y., Zhang, F., Yuan, M., ... & You, C. (2021). The prognostic value of the acute phase systemic ımmune–ınflammation ındex in patients with ıntracerebral hemorrhage. Frontiers in Neurology, 12, 628557.
  • Limaye, K., Yang, J.D. & Hinduja, A. (2016). Role of admission serum albumin levels in patients with intracerebral hemorrhage. Acta Neurologica Belgica, 116(1), 27-30.
  • Loftspring, M.C., Johnson, H., Feng, R., Johnson, A.J. & Clark, J.F. (2011). Unconjugated bilirubin contributes to early inflammation and edema after intracerebral hemorrhage. Journal of Cerebral Blood Flow & Metabolism, 31(4), 1133-1142.
  • Loftspring, M.C., McDole, J., Lu, A., Clark, J.F. & Johnson, A.J. (2009). Intracerebral hemorrhage leads to infiltration of several leukocyte populations with concomitant pathophysiological changes. Journal of Cerebral Blood Flow & Metabolism, 29(1), 137-143.
  • Lu, L.H., Zhang, Y.F., Mu-Yan, C., Kan, A., Zhong, X.P., Mei, J., ... & Guo, R.P. (2019). Platelet-albumin-bilirubin grade: risk stratification of liver failure, prognosis after resection for hepatocellular carcinoma. Digestive and Liver Disease, 51(10), 1430-1437.
  • Mackenzie, J.M. & Clayton, J.A. (1999). Early cellular events in the penumbra of human spontaneous intracerebral hemorrhage. Journal of Stroke and Cerebrovascular Diseases,8(1), 1-8.
  • Morotti, A., Marini, S., Lena, U.K., Crawford, K., Schwab, K., Kourkoulis, C., ... & Goldstein, J.N. (2017). Significance of admission hypoalbuminemia in acute intracerebral hemorrhage. Journal of Neurology, 264(5), 905-911.
  • Mracsko, E., Javidi, E., Na, S.Y., Kahn, A., Liesz, A. & Veltkamp, R. (2014). Leukocyte invasion of the brain after experimental intracerebral hemorrhage in mice. Stroke, 45(7), 2107-2114.
  • Qi, H., Wang, D., Deng, X. & Pang, X. (2018). Lymphocyte-to-monocyte ratio is an independent predictor for neurological deterioration and 90-day mortality in spontaneous intracerebral hemorrhage. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 24, 9282.
  • Sansing, L.H., Harris, T.H., Kasner, S.E., Hunter, C.A. & Kariko, K. (2011). Neutrophil depletion diminishes monocyte infiltration and improves functional outcome after experimental intracerebral hemorrhage. In Intracerebral Hemorrhage Research (pp. 173-178). Springer, Vienna.
  • Sansing, L.H., Kaznatcheeva, E.A., Perkins, C.J., Komaroff, E., Gutman, F.B. & Newman, G.C. (2003). Edema after intracerebral hemorrhage: correlations with coagulation parameters and treatment. Journal of Neurosurgery, 98(5), 985-992.
  • Shao, Z., Tu, S. & Shao, A. (2019). Pathophysiological mechanisms and potential therapeutic targets in intracerebral hemorrhage. Frontiers in Pharmacology, 10, 1079.
  • Sims, J.R., Gharai, L.R., Schaefer, P.W., Vangel, M., Rosenthal, E.S., Lev, M.H. & Schwamm, L.H. (2009). ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology, 72(24), 2104-2110.
  • Thakkar, M., Edelenbos, J. & Doré, S. (2019). Bilirubin and ischemic stroke: rendering the current paradigm to better understand the protective effects of bilirubin. Molecular Neurobiology, 56(8), 5483-5496.
  • Trifan, G. & Testai, F. D. (2020). Systemic Immune-Inflammation (SII) index predicts poor outcome after spontaneous supratentorial intracerebral hemorrhage. Journal of Stroke and Cerebrovascular Diseases, 29(9), 105057.
  • Volbers, B., Giede-Jeppe, A., Gerner, S.T., Sembill, J.A., Kuramatsu, J.B., Lang, S., ... & Huttner, H.B. (2018). Peak perihemorrhagic edema correlates with functional outcome in intracerebral hemorrhage. Neurology, 90(12), e1005-e1012.
  • Wagner, K.R., Sharp, F.R., Ardizzone, T.D., Lu, A. & Clark, J.F. (2003). Heme and iron metabolism: role in cerebral hemorrhage. Journal of Cerebral Blood Flow & Metabolism, 23(6), 629-652.
  • Wang, J. (2010). Preclinical and clinical research on inflammation after intracerebral hemorrhage. Prog Neurobiology, 92 (4):463-477.
  • Yang, Y.L., Wu, C.H., Hsu, P.F., Chen, S.C., Huang, S.S., Chan, W.L., ... & Leu, H.B. (2020). Systemic immune‐inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. European Journal of Clinical Investigation, 50(5), e13230.
  • Zhang, W., & Shen, Y. (2018). Platelet-to-lymphocyte ratio as a new predictive index of neurological outcomes in patients with acute intracranial hemorrhage: A retrospective study. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 24, 4413.
  • Zhao, X., Ting, S.M., Sun, G., Roy-O’Reilly, M., Mobley, A. S., Bautista Garrido, J., ... & Aronowski, J. (2018). Beneficial role of neutrophils through function of lactoferrin after intracerebral hemorrhage. Stroke, 49(5), 1241-1247.
  • Zhou, Y., Wang, Y., Wang, J., Stetler, R.A. & Yang, Q. W. (2014). Inflammation in intracerebral hemorrhage: from mechanisms to clinical translation. Progress in Neurobiology, 115, 25-44.
There are 37 citations in total.

Details

Primary Language English
Subjects Primary Health Care
Journal Section Research Articles
Authors

Aslı Bolayır 0000-0001-6566-3751

Hasan Ata Bolayır 0000-0002-3557-1175

Şeyda Figül Gökçe 0000-0002-2719-0428

Burhanettin Çiğdem 0000-0003-4941-9497

Sibel Çıplak 0000-0002-2304-8125

Project Number Yok
Publication Date December 23, 2022
Submission Date August 5, 2022
Published in Issue Year 2022 Volume: 1 Issue: 3

Cite

APA Bolayır, A., Bolayır, H. A., Gökçe, Ş. F., Çiğdem, B., et al. (2022). Evaluation of platelet-albumin-bilirubin (PALBI) and systemic immune-inflammation (SII) indices in acute intracerebral hemorrhage. Journal of Medical Topics and Updates, 1(3), 142-151.