Clinical commentary
Prognostic value of peripheral leukocyte counts and plasma glucose in intracerebral haemorrhage

https://doi.org/10.1016/j.jocn.2017.03.032Get rights and content

Highlights

  • 1400 patients were admitted with stroke, of which 114 were haemorrhagic.

  • Lower blood glucose, leukocyte and neutrophil count were associated with survival.

  • Predicted correct group membership (survived/deceased) in 72.2% of cases.

  • In females with normal variables, survival was predicted with 96% accuracy.

Abstract

Introduction

The value of routine blood markers as prognostic indicators is increasingly established in acute ischaemic stroke. The relationship is less well defined in haemorrhagic stroke. In this study, we examined routine admission blood markers and applied a logistic regression model to predict outcome in haemorrhagic stroke.

Method

A retrospective study was performed between September 2009–2011 in a general admission stroke unit in the UK. 1400 patients were admitted with stroke during this period, of which 117 were haemorrhagic. Admission systolic and diastolic blood pressure, venous blood samples and pre- and post-morbid (i.e. at discharge or death) modified Rankin scores were also recorded. Patients were controlled for age, sex, smoking status, hypertension status and co-morbidities (using Charleson Comorbidity Index scores). Logistic regression models were generated using SPSS.

Results

113 patients were analysed (58 male/55 female). Lower admission blood glucose (p = 0.009), lower total leukocyte count (p = 0.001) and lower neutrophil count (p = 0.021) were found to be significantly associated with survival vs. death. 90 patients with complete glucose, leukocyte count, sex (forced) and pre-morbid Rankin score (forced) data were entered into a logistic regression model. This predicted correct group membership (survived/deceased) in 72.2% of cases (83.9% survivors/52.9% deceased correctly predicted). In females with normal leukocyte count and glucose, survival was predicted with 68% accuracy.

Conclusion

These results suggest that a logistic regression model using low admission glucose and low total leukocyte count may be markers of better prognosis in acute haemorrhagic stroke with a differential effect between sexes.

Introduction

Acute non-traumatic intracerebral haemorrhage (ICH) is a major public health problem with an incidence that has remained unchanged over the past thirty years [1]. It currently accounts for only about one-fifth of the 16.8 million strokes that occur annually but is known to have a higher mortality than other stroke subtypes and, unlike ischaemic stroke, mortality from this disease has not improved over the past decade [2], [3], [4]. It also accounts for a disproportionately greater number of the “productive life years lost” due to strokes since it tends to affect people at earlier ages compared with acute ischaemic stroke [2].

The treatment options for ICH range from supportive care to more aggressive interventions such as decompressive surgery. These interventions may carry a significantly higher risk to the patient yet it is not currently possible to clearly identify which patients should be treated most intensively.

A reliable and accurate prognostic biomarker in ICH would be valuable for a number of reasons. Firstly, it would allow patients to be stratified according to their expected clinical outcomes. This would be enormously useful in informing clinical decision-making as well as by aiding in the selection of patients for trials of new treatments. A routine marker that gives an early impression of prognosis would also be useful to clinicians when counselling patients and their families. Moreover, since the pathophysiology of neuronal damage in ICH is poorly understood, new biomarkers may direct and inform studies to understand the disease mechanisms of this devastating condition.

Various biomarkers for brain injury have been extensively studied in recent decades, with recognition that these could revolutionise the delivery of care post-injury [5]. However, relatively few studies have focused on biomarkers for non-traumatic brain injuries. In this retrospective study, we aimed to identify markers that could be suitable in offering predictive value for mortality during hospital-stay. We only examined clinical parameters that would be routinely available for every patient who is admitted to hospital.

Section snippets

Patient selection

We retrospectively reviewed of all cases of stroke admitted to Queen Elizabeth Hospital, King’s Lynn between 2009 and 2011, and selected all radiologically confirmed cases of haemorrhagic stroke (intracerebral haemorrhage) for further analysis. Cases of acute ischaemic stroke, sub-arachnoid and sub-dural haemorrhage were excluded.

Routine data on demographics and co-morbidities were obtained. Additionally, other baseline parameters including systolic and diastolic blood pressure and highest

Results

113 patients were analysed (55 female), of whom 73 survived the admission and 40 were deceased. There was no significant difference in age, sex nor co-morbidity across survival (Table 1), although sex is of borderline non-significance (p = 0.079).

Comparison of admission clinical and laboratory parameters (Table 2) revealed admission plasma glucose, leukocyte and neutrophil counts to be significantly higher in patients who died.

Patients with complete sets of plasma glucose, leukocyte count, sex

Discussion

This study shows that elevated plasma glucose and peripheral leukocyte count, within the first 24 h of hospital admission, both predict in-hospital mortality after ICH. This correlation was independent of the patient’s sex and previous health. Further, there was found to be no significant correlation between either systolic or diastolic blood pressure and the in-hospital mortality.

Conclusions

The strengths of this study were that simple clinical parameters were being measured- those that would be routinely available to clinicians upon admission. Moreover, the measure of in-hospital mortality, rather than long-term outcomes or disability, allows for predictive value for clinicians in making immediate clinical decisions and considering prognosis. However, this study is limited in that it is a retrospective, single centre analysis. Moreover, it should be considered that infection is a

References (13)

There are more references available in the full text version of this article.

Cited by (0)

1

Both authors contributed equally.

View full text