Abstract
Background: Inflammation has been shown to play a role in animal models of intracerebral hemorrhage, but actually its role in predicting outcome in spontaneous intracerebral hemorrhage (sICH) is not clear because of the lack of evidence. This study was designed to determine the relationship between baseline white blood cell (WBC) count and clinical outcomes in patients with sICH and to see if WBC count was a significant predictor of outcomes independent of other in fl ammatory biomarkers such as C-reactive protein (CRP) a well de fi ned prognostic marker in ischemic stroke. Methods: We evaluated the relationship between baseline WBC count, other baseline variables and biomarkers, neuroradiological fi ndings, and clinical outcomes in 175 consecutive patients with a well-de fi ned diagnosis of sICH admitted into 24 hours in 3 primary referred centers and included in a prospective observational follow-up registry . Results: Higher baseline wbc counts were associated with hematoma volume at admission (p<0.0001) as well as a greater sich severity (p=0.0016) assessed by glasgow coma scale. a higher baseline wbc count was predictive of higher 30-day mortality, ranging from 10.42% among patients with the lowest wbc count quartile to 66.7 among patients with he highest wbc count quartile (p=<0.0001, χ 2 for trend). however, in a multivariable proportional hazards model, wbc count was unable to con fi rm its predictive prognostic value when adjusted for possible confounding variables and crp concentration quartiles [hazards ratios (hr) 1.23 95% con fi dence intervals (ci) 0.41-3.68, p=0.7079] while patients with the highest crp concentrations at admission showed a significantly higher risk of 30-day death (hr 2.83, 95%ci 1.14-7.05, p=0.0254) although, crp levels were only lightly associated with stroke severity (p=0.0747). Conclusions: In patients with sICH, the WBC count was associated with 30-day high mortality rates although, this association reversed when other confounding variables were taken in account suggesting only a role of surrogate biomarker of sICH severity. CRP concentrations appeared more effective in predicting prognosis although its predictive power is limited.
Highlights
Spontaneous intracerebral hemorrhage, defined as spontaneous bleeding into the brain, accounts for 10% to 20% of all strokes [1]. spontaneous intracerebral hemorrhage (sICH) is a devastating clinical event without effective therapies despite progressing in medical knowledge [1,2,3,4] with poor outcome[5]
white blood cell (WBC) was strongly correlated with hematoma volume at admission (r2 = 0.33, P
WBC was strongly associated with sICH severity
Summary
Spontaneous intracerebral hemorrhage (sICH), defined as spontaneous bleeding into the brain, accounts for 10% to 20% of all strokes [1]. sICH is a devastating clinical event without effective therapies despite progressing in medical knowledge [1,2,3,4] with poor outcome[5]. Existing contemporary data collected from preclinical and clinical studies indicates that inflammatory processes are involved in sICH [6] and in the progression of sICH-induced brain injury [6,7]. Several prospective studies have been indicated that brain injury secondary to a sICH is characterized by acute local inflammation [7,8,9] and changes in levels of inflammatory cytokines in body fluids of human patients [10,11,12,13]. This study was designed to determine the relationship between baseline white blood cell (WBC) count and clinical outcomes in patients with sICH and to see if WBC count was a significant predictor of outcomes independent of other inflammatory biomarkers such as C-reactive protein (CRP) a well defined prognostic marker in ischemic stroke
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