Do early neutrophil to eosinophil ratio and the levels of neutrophil and white blood cells predict intra-hospital mortality in patients with spontaneous intracerebral hemorrhages?

Abstract

Aim: In recent years, inflammatory markers such as red blood cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and C-reactive protein to albumin ratio (CAR) have been investigated in spontaneous intracerebral hemorrhage (ICH). However, they were not analyzed together in ICH. In the present study, we examined whether neutrophil, neutrophil to eosinophil ratio (NER), and white blood cell (WBC) levels along with the above-mentioned markers predict the intrahospital mortality in patients diagnosed with spontaneous ICH at admission. Methods: We conducted this retrospective cohort study by examining spontaneous ICH patients hospitalized in our clinic between April 2015 and March 2019. We divided patients into two groups, as survivors and non-survivors. The receiver operating characteristics (ROC) curve analysis test was used to evaluate the predictive value of laboratory variables for mortality and to calculate cut-off values. Results: A total of 130 patients, 82 survivors and 48 non-survivors, were included in the study. The patients who were non-survivors at the hospital had significantly higher median hemorrhage volume, WBC, and neutrophil levels compared to those of survivors (P<0.001, P=0.001 and P=0.003, respectively). There was no significant difference between the two groups in terms of median CAR, NLR, NER, and RDW-SD values (P=0.216, P=0.237, P=0.229, and P=0.215, respectively). The area under the ROC curve was 0.676 (95% CI, 0.57-0.78) for WBC and 0.659 (95% CI, 0.56-0.76) for neutrophil. Conclusion: Our results showed that the elevated neutrophil and WBC levels at the acute phase of spontaneous ICH predict the intrahospital mortality of the patients. Further studies are required for the predictive value of NER.

Keywords

• White blood cell
• Spontaneous intracerebral hemorrhage
• Neutrophil
• Inflammatory parameters
• Red blood cell distribution width
• Neutrophil/lymphocyte ratio
• Neutrophil/eosinophil ratio

Erken nötrofil/eozinofil oranı ile nötrofil ve beyaz kan hücrelerinin seviyeleri spontan intraserebral hemorajili hastalarda hastane içi mortaliteyi öngörüyor mu?

Öz

Amaç: Son yıllarda, spontan intraserebral hemorajide (ICH) kırmızı kan hücresi dağılım genişliği (RDW), nötrofil/lenfosit oranı (NLO) ve C-reaktif protein/albümin oranı (CAO) gibi inflamatuar belirteçler araştırılmıştır. Ancak, bunlar ICH’de birlikte incelenmemiştir. Bu çalışmada, spontan ICH tanısı alan hastalarda başvuru sırasında yukarıda belirtilen belirteçlerle birlikte nötrofil, nötrofil/eozinofil oranı (NEO) ve beyaz kan hücresi (WBC) düzeylerinin hastane içi mortaliteyi tahmin edip etmediğini araştırdık. Yöntemler: Bu retrospektif kohort çalışmasını, Nisan 2015 - Mart 2019 tarihleri arasında kliniğimizde yatan spontan ICH hastalarını inceleyerek gerçekleştirdik. Hastaları hayatta kalanlar ve hayatta kalmayanlar olarak iki gruba ayırdık. Mortalite için laboratuvar değişkenlerinin prediktif değerini değerlendirmek ve kesme değerlerini hesaplamak için, alıcı çalışma karakteristikleri (ROC) eğrisi analizi kullanılmıştır. Bulgular: Çalışmaya, 82’si hayatta kalan ve 48’i hayatta kalmayan olmak üzere 130 hasta dahil edildi. Hastanede ölen hastaların medyan hemoraji hacmi, WBC ve nötrofil değerleri yaşayanlara göre anlamlı olarak yüksekti (sırasıyla P<0,001; P=0,001 ve P=0,003). Medyan CAO, NLO, NEO ve RDW-SD değerleri açısından iki grup arasında fark yoktu (sırasıyla P=0,216; P=0,237; P=0,229 ve P=0,215). ROC eğrisi altındaki alan: WBC için 0,676 (% 95 CI; 0,57-0,78) ve nötrofil için 0,659 (% 95 CI; 0,56-0,76) idi. Sonuç: Sonuçlarımız, spontan ICH'nin akut evresinde daha yüksek nötrofil ve WBC düzeyleri hastaların hastane içi mortalitesini öngörmüştür. NEO’nın predikdif değeri için ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Beyaz kan hücresi
• Spontan intraserebral hemoraji
• Nötrofil
• İnflamatuvar parametreler
• Kırmızı kan hücresi dağılım genişliği
• Nötrofil/lenfosit oranı
• Nötrofil/eozinofil oranı

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