Early neutrophil count relates to infarct size and fatal outcome after large hemispheric infarction
Open Access
- 6 May 2020
- journal article
- research article
- Published by Wiley in CNS Neuroscience & Therapeutics
- Vol. 26 (8), 829-836
- https://doi.org/10.1111/cns.13381
Abstract
Aims To investigate the relationship between peripheral leukocyte dynamics and the outcome of large hemispheric infarction (LHI) patients. Methods Patients with acute LHI admitted to the neuro‐intensive care unit of Xuanwu Hospital from 2013 to 2017 were prospectively enrolled and followed up for 6 months after LHI. Results A total of 84 LHI patients were included, 38 patients suffered brain herniation and 20 patients died from stroke. Compared to patients with benign course, LHI patients with fatal outcome showed larger infarcts and more severe brain edema (P < .01), as well as increased WBC and neutrophil counts throughout the first week after stroke (P < .05). Correlation analysis revealed that neutrophil counts on D2 after LHI positively correlated with infarct and edema volumes measured from CT/MRI (R2 = 0.22 and R2 = 0.15, P < .01) and negatively correlated with Glasgow Coma Scale (ρ = −0.234, P < .05). Patients with D2 neutrophils > 7.14 × 109/L had higher risk of brain herniation [odds ratio (OR) = 7.5, 95% CI: 2.0‐28.1, P = .001], and patients with D2 neutrophils > 7.79 × 109/L had a higher risk of death (OR = 5.8, 95% CI: 1.2‐27.0, P = .015). Conclusion Early peripheral neutrophil count after stroke relates to infarct size and the fatal outcome of LHI patients, which might help guiding acute LHI management such as reduction of intracranial pressure and potential antiinflammatory therapy in the future.Keywords
Funding Information
- Chinese Natural Science Fund (81671037)
- Xuanwu Hospital Fund (XWJL-2019008)
- Capital Medical University Science Cultivation Fund (PYZ19129)
This publication has 22 references indexed in Scilit:
- Implications of polymorphonuclear neutrophils for ischemic stroke and intracerebral hemorrhage: Predictive value, pathophysiological consequences and utility as therapeutic targetJournal of Neuroimmunology, 2018
- Genetic neutrophil deficiency ameliorates cerebral ischemia-reperfusion injuryExperimental Neurology, 2017
- Evidence-Based Guidelines for the Management of Large Hemispheric InfarctionNeurocritical Care, 2015
- Hemicraniectomy in Older Patients with Extensive Middle-Cerebral-Artery StrokeThe New England Journal of Medicine, 2014
- Guidelines for the Early Management of Patients With Acute Ischemic StrokeStroke, 2013
- Decompressive Hemicraniectomy in Malignant Middle Cerebral Artery Infarct: A Randomized Controlled Trial Enrolling Patients up to 80 Years OldNeurocritical Care, 2012
- The immunology of stroke: from mechanisms to translationNature Medicine, 2011
- Cerebral Neutrophil Recruitment, Histology, and Outcome in Acute Ischemic StrokeStroke, 2004
- Noninvasive Quantification of Brain Edema and the Space-Occupying Effect in Rat Stroke Models Using Magnetic Resonance ImagingStroke, 2004
- Large hemispheric infarction, deterioration, and intracranial pressureNeurology, 1995