Abstract
(1) Background: We investigated the association of four immune-inflammatory markers with clinical features and established location-specific nomograms to predict mortality risk in patients with intracerebral hemorrhage (ICH). (2) Methods: We retrospectively enrolled 613 inpatients with acute ICH. (3) Results: Overall mortality was 22%, which was highest in pontine hemorrhage and lowest in thalamic hemorrhage. All four immune-inflammatory markers exhibited a positive linear correlation with glucose, ICH volume, ICH score, and discharge Modified Rankin Scale (mRS) score. Significant predictors of death due to lobar/putaminal hemorrhage were age, glucose and creatinine levels, initial Glasgow Coma Scale (GCS) score, ICH volume, and presence of intraventricular hemorrhage. None of the immune-inflammatory markers were significant predictors of unfavorable outcome or death. We selected significant factors to establish nomograms for predicting death due to lobar/putaminal, thalamic, pontine, and cerebellar hemorrhages. The C-statistic for predicting death in model I (comprising factors in the establishment of the nomogram) in each type of ICH was higher than that in model II (comprising ICH score alone), except for cerebellar hemorrhage. These nomograms for predicting death had good discrimination (C-index: 0.889 to 0.975) and prediction probabilities (C-index: 0.890 to 0.965). (4) Conclusions: Higher immune-inflammatory markers were associated with larger ICH volume, worse initial GCS, and unfavorable outcomes, but were not independent prognostic predictors. The location-specific nomograms provided novel and accurate models for predicting mortality risk.
Highlights
Hemorrhagic stroke accounts for 8–15% of strokes in Western countries and 18–24% inAsian countries and carries a much higher risk of mortality than ischemic stroke does [1–4].Immune-inflammatory processes are involved in all stages of acute stroke, including ischemic and hemorrhagic strokes [5–8]
The inclusion criteria were (1) a diagnosis of acute intracerebral hemorrhage (ICH) confirmed with clinical presentations and (2) evidence of hemorrhagic lesions according to brain computed tomography (CT) or magnetic resonance imaging
Laboratory data obtained on arrival at the emergency department included complete blood count with white blood cell (WBC) differentials, platelet count, C-reactive protein (CRP), and glucose and creatinine levels, which were measured in the hospital central laboratory using an XN-9000 Compact Integration
Summary
Asian countries and carries a much higher risk of mortality than ischemic stroke does [1–4]. Immune-inflammatory processes are involved in all stages of acute stroke, including ischemic and hemorrhagic strokes [5–8]. Innate immunity—the immune response present at birth—is mainly provided by neutrophils, monocytes, macrophages, natural killer cells, and complement systems. Adaptive (or acquired) immunity is provided by lymphocytes, which deliver antigen-dependent and antigen-specific responses to invasion [9]. The white blood cell (WBC) count, neutrophil count (NC), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) represent the status of an inflammatory response and are regarded as immune-inflammatory markers; their high levels are independent risk factors for poor outcomes in patients with acute ischemic stroke [10–12]. The association of immune-inflammatory marker levels with the outcomes of patients with acute hemorrhagic stroke remains controversial [7,13–15]
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