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The Relationship between Hospital Mortality and Hematological Parameters in Acute Ischemic Stroke Patients

Year 2020, Volume: 7 Issue: 1, 45 - 49, 28.04.2020

Abstract

In recent years there are many pieces of research about various haematologic parameters that were related to the prognosis of atherosclerosis and thromboembolic events. In our study we searched possible prognostic factors predicting hospital mortality in patients with acute ischemic stroke in neurology intensive care unit. We examined ninety-nine acute ischemic stroke patients which were followed in neurology intensive care unit, between January 01, 2019 and December 31, 2019. History, neurologic examination, computed tomography and diffusion weighted MRI of brain were applied for acute ischemic stroke diagnosis. Age, gender, ischemic lesions' localisation and hematologic parameters, (leukocyte, neutrophil, lymphocyte, monocyte, hemoglobin, platelet, mean platelet volume-MPV, red cell distribution width-RDW, neutrophil/lymphocyte ratio-NLO, platelet/lymphocyte ratio-PLO, lymphocyte / monocyte ratio-LMO) were compared to find possible prognostic factors which could be correlated with hospital mortality. In this study; age, gender, ischemic lesions indicated no difference for hospital mortality. In additional haematologic parameters indicated no significant difference except lymphocyte-to-monocyte ratio (LMR). Lymphocyte-to-monocyte ratio (LMR:2.06±1.46, p=0.011, sensitivity: 61.7%, specificity: 48.1%) was statistically lower in patients who died in the hospital. Based on the study results, lowe rlymphocyte-to-monocyte ratio (LMR) is a haematologic parameter for predicting hospital mortality for acute ischemic stroke patients. However, more detailed and prospective research should be carried out in this field.

References

  • 1. Bennett DA, Krishnamurthi RV, Barker-Collo S, et al. The global burden of ischemic stroke: findings of the GBD2010 study. Glob Heart. 2014;9:107-12.
  • 2. Türkiye İstatistik Kurumu. [Internet]. 2018 yılı ölüm nedeni istatistiği, http://tuik.gov.tr/PreTablo.do?alt_id=1083.
  • 3. Petrovic-Djergovic D, Goonewardena SN, Pinsky DJ. Inflammatory disequilibrium in stroke. Circ Res. 2016;119:142-58.
  • 4. Rodrigues SF, Granger DN. Leukocyte-mediated tissue injury in ischemic stroke. Curr Med Chem, 2014; 21: 2130–7.
  • 5. Altintas O, Altintas MO, Tasal A, et al. The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarct core in acute ischemic stroke patients who have undergone endovascular therapy. Neurol Res. 2016;38(9):759-65.
  • 6. Petrone AB, Eisenman RD, Steele KN, et al. Temporal dynamics of peripheral neutrophil and lymphocytes following acute ischemic stroke. Neurol Sci. 2019;40(9):1877-85. 7. Song SY, Hua C, Dornbors D 3rd. et al. Baseline red blood cell distribution width as a predictor of stroke occurrence and outcome: A comprehensive meta-analysis of 31 studies. Front Neurol. 2019;10:1237.
  • 8. Herz J, Sabellek P, Lane TE, et al. Role of neutrophils in exacerbation of brain injury after focal cerebral ischemia in hyperlipidemic mice. Stroke. 2015;46:2916–25.
  • 9. Zhu JY, Liu CC, Wang L, et al. Peripheral blood lymphocyte-to-monocyte ratio as a prognostic factor in advanced epithelial ovarian cancer: a multicenter retrospective study. J Cancer. 2017;8:737-43.
  • 10. Kiris T, Celik A, Varis E, et al. Association of lymphocyte-to-monocyte ratio with the mortality in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Angiology. 2017;3319716685480.
  • 11. Liesz A, Suri-Payer E, Veltkamp C, et al. Regulatory T cells are key cerebroprotective immunomodulators in acute experimental stroke. Nat Med. 2009;15:192-9.
  • 12. Ren H, Liu X, WangL, et al. Lymphocyte-to-monocyte ratio: a novel predictor of the prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis. 2017; 26(11): 2595–602.
  • 13. Bonifacic D, Toplak A, Benjak I, et al. Monocytes and monocyte chemoattractant protein 1 (MCP-1) as early predictors of disease outcome in patients with cerebral ischemic stroke. Wien KlinWochenschr. 2016;128:20-7.
  • 14. Kim J, Song TJ, Park JH, et al. Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis. 2012; 222: 464–7.
  • 15. Kim JY, Park J, Chang JY, et al. Inflammation after ischemic stroke: the role of leukocytes and glial cells. Exp Neurobiol. 2016;25:241–51.
  • 16. Luo Fan, Li Gui, Er-Qing Chai, et al. Routine hematological parameters are associated with short-and long-term prognosis of patients with ischemic stroke. J Clin Lab Anal. 2018;32:e22244.
  • 17. Jing Zhang, Qingqing Ren, Yanlin Song, et al. Prognostic role of neutrophil–lymphocyte ratio in patients with acute ischemic stroke. Medicine. 2017; 96(45): e8624.
  • 18. Pektezel MY, Yilmaz E, Arsava EM, et al. Neutrophil-to-Lymphocyte Ratio and response to ıntravenous thrombolysis in patients with acute ıschemic stroke. Stroke Cerebrovasc Dis. 2019;28(7):1853-9.
  • 19. Xue J, Huang W, Chen X, et al. Neutrophil-to-lymphocyte ratio is a prognostic marker in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2017;26:650–7.
  • 20. Kim JY, Kawabori M, Yenari MA. Innate inflammatory responses in stroke: mechanisms and potential therapeutic targets. Curr Med Chem. 2014;21:2076–97.
  • 21. Anrather J, Iadecola C. Inflammation ands troke: an overview. Neurother. 2016;13:661-70.

Akut İskemik İnmeli Hastalarda Hastane Mortalitesi ile Hematolojik Parametrelerin İlişkisi

Year 2020, Volume: 7 Issue: 1, 45 - 49, 28.04.2020

Abstract

Son yıllarda çeşitli hematolojik parametrelerin ateroskleroz ve tromboembolik olayların prognozu ile ilişkilendirildiği birçok çalışma mevcuttur. Biz bu çalışmada nöroloji yoğun bakım ünitesine akut iskemik inme tanısı ile yatırılan hastalarda, hastane mortalitesini ön görmeye katkı sağlayabilecek muhtemel prognostik faktörleri araştırdık. Bu çalışmaya 01.01.2019-31.12.2019 tarihleri arasında acil serviste akut iskemik inme tanısı aldıktan sonra nöroloji yoğun bakım ünitesine yatırılan 99 hasta dahil edildi. Akut iskemik inme tanısı için hastaların tıbbi öyküsü, nörolojik muayene bulguları, bilgisayarlı tomografi, difüzyon MR görüntüleri kullanıldı. Hastane mortalitesi ile ilişkili olabilecek olası prognostik faktörleri bulmak için yaş, cinsiyet, iskemik lezyonların lokalizasyonu ve hematolojik parametreler (lökosit, nötrofil, lenfosit, monosit, hemoglobin, platelet, mean platelet volume-MPV, red cell distrubition width-RDW, nötrofil/lenfosit oranı-NLO, platelet/lenfosit oranı-PLO, lenfosit/monosit oranı-LMO) karşılaştırıldı. Bu çalışmada; yaş, cinsiyet ve iskemik lezyonlar ile hastane mortalitesi arasında anlamlı farklılık saptanmadı. Ayrıca lenfosit-monosit oranı (LMO) dışındaki hematolojik parametrelerde de anlamlı bir farklılık saptanmadı. Lenfosit-monosit oranı (LMO:2.06±1.46, p=0.011, sensitivite: %61.7, spesifite: %48.1) hastanede eksitus olan hastalarda istatiksel anlamlı olarak daha düşük bulundu. Sonuç olarak, düşük lenfosit-monosit oranının erken dönem prognozu göstermede faydalı olabilecek bir hematolojik belirteç olduğu, ancak bu konuda daha kapsamlı ve prospektif çalışmaların gerektiği kanaatine varıldı.

References

  • 1. Bennett DA, Krishnamurthi RV, Barker-Collo S, et al. The global burden of ischemic stroke: findings of the GBD2010 study. Glob Heart. 2014;9:107-12.
  • 2. Türkiye İstatistik Kurumu. [Internet]. 2018 yılı ölüm nedeni istatistiği, http://tuik.gov.tr/PreTablo.do?alt_id=1083.
  • 3. Petrovic-Djergovic D, Goonewardena SN, Pinsky DJ. Inflammatory disequilibrium in stroke. Circ Res. 2016;119:142-58.
  • 4. Rodrigues SF, Granger DN. Leukocyte-mediated tissue injury in ischemic stroke. Curr Med Chem, 2014; 21: 2130–7.
  • 5. Altintas O, Altintas MO, Tasal A, et al. The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarct core in acute ischemic stroke patients who have undergone endovascular therapy. Neurol Res. 2016;38(9):759-65.
  • 6. Petrone AB, Eisenman RD, Steele KN, et al. Temporal dynamics of peripheral neutrophil and lymphocytes following acute ischemic stroke. Neurol Sci. 2019;40(9):1877-85. 7. Song SY, Hua C, Dornbors D 3rd. et al. Baseline red blood cell distribution width as a predictor of stroke occurrence and outcome: A comprehensive meta-analysis of 31 studies. Front Neurol. 2019;10:1237.
  • 8. Herz J, Sabellek P, Lane TE, et al. Role of neutrophils in exacerbation of brain injury after focal cerebral ischemia in hyperlipidemic mice. Stroke. 2015;46:2916–25.
  • 9. Zhu JY, Liu CC, Wang L, et al. Peripheral blood lymphocyte-to-monocyte ratio as a prognostic factor in advanced epithelial ovarian cancer: a multicenter retrospective study. J Cancer. 2017;8:737-43.
  • 10. Kiris T, Celik A, Varis E, et al. Association of lymphocyte-to-monocyte ratio with the mortality in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Angiology. 2017;3319716685480.
  • 11. Liesz A, Suri-Payer E, Veltkamp C, et al. Regulatory T cells are key cerebroprotective immunomodulators in acute experimental stroke. Nat Med. 2009;15:192-9.
  • 12. Ren H, Liu X, WangL, et al. Lymphocyte-to-monocyte ratio: a novel predictor of the prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis. 2017; 26(11): 2595–602.
  • 13. Bonifacic D, Toplak A, Benjak I, et al. Monocytes and monocyte chemoattractant protein 1 (MCP-1) as early predictors of disease outcome in patients with cerebral ischemic stroke. Wien KlinWochenschr. 2016;128:20-7.
  • 14. Kim J, Song TJ, Park JH, et al. Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis. 2012; 222: 464–7.
  • 15. Kim JY, Park J, Chang JY, et al. Inflammation after ischemic stroke: the role of leukocytes and glial cells. Exp Neurobiol. 2016;25:241–51.
  • 16. Luo Fan, Li Gui, Er-Qing Chai, et al. Routine hematological parameters are associated with short-and long-term prognosis of patients with ischemic stroke. J Clin Lab Anal. 2018;32:e22244.
  • 17. Jing Zhang, Qingqing Ren, Yanlin Song, et al. Prognostic role of neutrophil–lymphocyte ratio in patients with acute ischemic stroke. Medicine. 2017; 96(45): e8624.
  • 18. Pektezel MY, Yilmaz E, Arsava EM, et al. Neutrophil-to-Lymphocyte Ratio and response to ıntravenous thrombolysis in patients with acute ıschemic stroke. Stroke Cerebrovasc Dis. 2019;28(7):1853-9.
  • 19. Xue J, Huang W, Chen X, et al. Neutrophil-to-lymphocyte ratio is a prognostic marker in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2017;26:650–7.
  • 20. Kim JY, Kawabori M, Yenari MA. Innate inflammatory responses in stroke: mechanisms and potential therapeutic targets. Curr Med Chem. 2014;21:2076–97.
  • 21. Anrather J, Iadecola C. Inflammation ands troke: an overview. Neurother. 2016;13:661-70.
There are 20 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section Original Article
Authors

Mehmet Tayfun Kaşıkcı 0000-0001-7256-6191

Sinan Yıldırım 0000-0001-8191-168X

Publication Date April 28, 2020
Submission Date March 8, 2020
Published in Issue Year 2020 Volume: 7 Issue: 1

Cite

APA Kaşıkcı, M. T., & Yıldırım, S. (2020). Akut İskemik İnmeli Hastalarda Hastane Mortalitesi ile Hematolojik Parametrelerin İlişkisi. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 7(1), 45-49.
AMA Kaşıkcı MT, Yıldırım S. Akut İskemik İnmeli Hastalarda Hastane Mortalitesi ile Hematolojik Parametrelerin İlişkisi. MMJ. April 2020;7(1):45-49.
Chicago Kaşıkcı, Mehmet Tayfun, and Sinan Yıldırım. “Akut İskemik İnmeli Hastalarda Hastane Mortalitesi Ile Hematolojik Parametrelerin İlişkisi”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 7, no. 1 (April 2020): 45-49.
EndNote Kaşıkcı MT, Yıldırım S (April 1, 2020) Akut İskemik İnmeli Hastalarda Hastane Mortalitesi ile Hematolojik Parametrelerin İlişkisi. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 7 1 45–49.
IEEE M. T. Kaşıkcı and S. Yıldırım, “Akut İskemik İnmeli Hastalarda Hastane Mortalitesi ile Hematolojik Parametrelerin İlişkisi”, MMJ, vol. 7, no. 1, pp. 45–49, 2020.
ISNAD Kaşıkcı, Mehmet Tayfun - Yıldırım, Sinan. “Akut İskemik İnmeli Hastalarda Hastane Mortalitesi Ile Hematolojik Parametrelerin İlişkisi”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 7/1 (April 2020), 45-49.
JAMA Kaşıkcı MT, Yıldırım S. Akut İskemik İnmeli Hastalarda Hastane Mortalitesi ile Hematolojik Parametrelerin İlişkisi. MMJ. 2020;7:45–49.
MLA Kaşıkcı, Mehmet Tayfun and Sinan Yıldırım. “Akut İskemik İnmeli Hastalarda Hastane Mortalitesi Ile Hematolojik Parametrelerin İlişkisi”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, vol. 7, no. 1, 2020, pp. 45-49.
Vancouver Kaşıkcı MT, Yıldırım S. Akut İskemik İnmeli Hastalarda Hastane Mortalitesi ile Hematolojik Parametrelerin İlişkisi. MMJ. 2020;7(1):45-9.