Clinical commentaryPrognostic value of peripheral leukocyte counts and plasma glucose in intracerebral haemorrhage
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)
- et al.
Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis
Lancet Neurol
(2010) - et al.
Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010
Lancet Glob Health
(2013) - et al.
Intracerebral haemorrhage
Lancet
(2009) - et al.
High glucose and hyperosmolarity increase secretion of interleukin-1 beta in cultured human aortic endothelial cells
J Diabetes Complications
(1997) - et al.
Hemorrhagic and ischemic strokes compared: stroke severity
Mortality Risk Factors Stroke
(2009) - et al.
Predictive markers in traumatic brain injury: opportunities for a serum biosignature
Br J Neurosurg
(2014)
Cited by (0)
- 1
Both authors contributed equally.