Association Between Neutrophil-Lymphocyte Ratio and 30-Day Infection and Thrombotic Outcomes After Intraventricular Hemorrhage: A CLEAR III Analysis

Clinical value of inflammatory indices in predicting poor prognosis and post-hemorrhagic hydrocephalus in patients with intraventricular hemorrhage

BACKGROUND

Hemorrhagic stroke has a high mortality and disability rate. Among them, intraventricular hemorrhage (IVH) is an important factor leading to adverse outcomes. IVH can induce acute obstructive hydrocephalus and chronic communicating hydrocephalus. However, there are currently no effective predictive factors for the early prediction of post-hemorrhage hydrocephalus (PHH).

OBJECTIVES

To assess the role of inflammatory indicators in predicting PHH and poor prognostic outcomes in patients with ventricular hemorrhage.

DESIGN

Single center retrospective case-control study.

METHODS

We retrospectively examined IVH patients treated at our institution from April 2017 to March 2022. Patient characteristics, laboratory data, imaging findings, and 3-month follow-up results were recorded and analyzed.

RESULTS

Among the 145 patients included in the analysis, 102 eventually developed adverse outcomes. There were significant differences between patients with good and poor prognosis in terms of age at admission, GCS score, prevalence of hypertension, lymphocyte count, albumin level, red blood cell distribution width, neutrophil count, NLR, PLR, NAR, PIV, and SII; in addition, among the 110 surviving patients, 36 eventually developed posthemorrhagic hydrocephalus within 3 months. Multivariate logistic regression showed that age and NAR are independent predictors of poor prognosis in IVH patients, while albumin is an independent predictor of posthemorrhagic hydrocephalus within 3 months.

CONCLUSION

The NLR and NAR are independent risk factors for poor prognosis in IVH patients. Additionally, albumin is an independent predictor of chronic hydrocephalus development within 3 months in IVH patients. The NLR, NAR and albumin level could provide prognostic information about IVH patients.

Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis

BACKGROUND

Nontraumatic intracerebral hemorrhage (ICH) is independently associated with a long-term increased risk of major arterial ischemic events. While the relationship between ICH location and ischemic risk has been studied, whether hematoma volume influences this risk is poorly understood.

METHODS

We pooled individual patient data from the MISTIE III (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase 3) and the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2) trials. The exposure was hematoma volume, treated as a continuous measure in the primary analysis, and dichotomized by the median in the secondary analyses. The outcome was a symptomatic, clinically overt ischemic stroke, adjudicated centrally within each trial. We evaluated the association between hematoma volume and the risk of an ischemic stroke using Cox regression analyses after adjustment for demographics, vascular comorbidities, and ICH characteristics.

RESULTS

Of 1470 patients with ICH, the mean age was 61.7 (SD, 12.8) years, and 574 (38.3%) were female. The median hematoma volume was 17.3 mL (interquartile range, 7.2-35.7). During a median follow-up of 107 days (interquartile range, 91-140), a total of 30 ischemic strokes occurred, of which 22 were in patients with a median ICH volume of ≥17.3 mL and a cumulative incidence of 4.6% (95% CI, 3.1-7.1). Among patients with a median ICH volume <17.3 mL, there were 8 ischemic strokes with a cumulative incidence of 3.1% (95% CI, 1.7-6.0). In primary analyses using adjusted Cox regression models, ICH volume was associated with an increased risk of ischemic stroke (hazard ratio, 1.02 per mL increase [95% CI, 1.01-1.04]). In secondary analyses, ICH volume of ≥17.3 mL was associated with an increased risk of ischemic stroke (hazard ratio, 2.5 [95% CI, 1.1-7.2]), compared with those with an ICH volume <17.3 mL.

CONCLUSIONS

In a heterogeneous cohort of patients with ICH, initial hematoma volume was associated with a heightened short-term risk of ischemic stroke.