Higher Monocyte Count is Associated with 30-Day Case Fatality in Intracerebral Hemorrhage

Introduction: Preclinical models suggest an inflammatory response mediated by monocytes may contribute to secondary injury after intracerebral hemorrhage (ICH). We recently found an association of absolute monocyte count (AMC) with 30-day case fatality following ICH. We sought to validate this finding in an independent cohort of ICH patients. Hypothesis: AMC is independently associated with 30-day case-fatality following ICH. Methods: The Ethnic/Racial Variations of ICH (ERICH) study is a prospective, multi-center, case-control study of ICH among Caucasian, Black, and Hispanic patients. In 241 adult patients with nontraumatic ICH within 24 hours of symptom onset, demographic information, Glasgow Coma Scale (GCS), ICH volume, 30-day case-fatality, total white blood cell (WBC) count, absolute neutrophil count (ANC), AMC, and hemoglobin concentration were determined. Participating centers were requested to obtain WBC differentials on the 30 most recently enrolled cases. After receiving data on 411 subjects, we excluded 170 subjects whose initial WBC was >24 hours from onset and in those where monocytes and neutrophils were not available, resulting in 241 cases for the analysis. Linear regression was used to evaluate factors associated with ICH volume (log transformed), and logistic regression for factors associated with 30-day case-fatality. Results: Mean age was 62.8 years (SD ± 14 years), 61.8% were men and 33.6% were Black. Median ICH volume was 9.7ml (IQR 4.3-26.7). After adjusting for patient age and initial hemoglobin, higher ANC (p= 0.001) and total WBC count (p=0.0005) were associated with larger ICH volume, whereas AMC was not (p=0.14). After adjusting for age, GCS, and ICH volume, baseline AMC was independently associated with higher 30-day case-fatality (OR 5.24, 95% CI 1.62-16.89, p=0.0056) whereas ANC (OR 0.85, CI 0.15-4.68, p=0.85) and WBC count (OR 0.58, CI 0.04-7.67, p=0.68) were not. Conclusions: In this independent cohort an association between higher admission monocytes and case fatality was corroborated independent of known clinical variables. This suggests a specific role of monocytes in secondary injury following ICH. Inflammatory and neuronal apoptotic pathways mediated by monocytes may be a target for neuroprotection in ICH.

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Monocyte Count and 30-Day Case Fatality in Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.115.009880 ◽

2015 ◽

Vol 46 (8) ◽

pp. 2302-2304 ◽

Cited By ~ 27

Author(s):

Kyle B. Walsh ◽

Padmini Sekar ◽

Carl D. Langefeld ◽

Charles J. Moomaw ◽

Mitchell S.V. Elkind ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Case Fatality ◽

Monocyte Count ◽

Day Case

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Peripheral Monocyte Count Is Associated with Case Fatality after Intracerebral Hemorrhage

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2013.09.006 ◽

2014 ◽

Vol 23 (2) ◽

pp. e107-e111 ◽

Cited By ~ 34

Author(s):

Opeolu Adeoye ◽

Kyle Walsh ◽

Jessica G. Woo ◽

Mary Haverbusch ◽

Charles J. Moomaw ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Case Fatality ◽

Monocyte Count ◽

Peripheral Monocyte

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Validation of the Intracerebral Hemorrhage Score in Uganda

Stroke ◽

10.1161/strokeaha.118.022057 ◽

2018 ◽

Vol 49 (12) ◽

pp. 3063-3066

Author(s):

Amir Abdallah ◽

Jonathan L. Chang ◽

Cumara B. O’Carroll ◽

Samson Okello ◽

Sam Olum ◽

...

Keyword(s):

Computed Tomography ◽

Relative Risk ◽

Intracerebral Hemorrhage ◽

Variance Estimation ◽

Case Fatality ◽

Sub Saharan Africa ◽

Adjusted Relative Risk ◽

Day Case ◽

Female Sex ◽

Ich Score

Background and Purpose— Rates of intracerebral hemorrhage (ICH) are estimated to be highest globally in sub-Saharan Africa. However, outcomes of ICH are poorly described and standard prognostic markers for ICH have not been validated in the region. Methods— We enrolled consecutive patients with computed tomography-confirmed ICH at a referral hospital in southwestern Uganda. We recorded demographic, clinical, and radiographic features of ICH, and calculated ICH scores. We fit Poisson regression models with robust variance estimation to determine predictors of case fatality at 30 days. Results— We enrolled 73 individuals presenting with computed tomography-confirmed ICH (mean age 60 years, 45% [33/73] female, and 14% [10/73] HIV-positive). The median ICH score was 2 (interquartile range, 1–3; range, 0–5). Case fatality at 30 days was 44% (32/73; 95% CI, 33%–57%). The 30-day case fatality increased with increasing ICH score of 0, 1, and 5 from 17%, 23%, to 100%, respectively. In multivariable-adjusted models, ICH score was associated with case fatality (adjusted relative risk, 1.48; 95% CI, 1.23–1.78), as were HIV infection (adjusted relative risk, 1.92; 95% CI, 1.07–3.43) and female sex (adjusted relative risk, 2.17; 95% CI, 1.32–3.59). The ICH score moderately improved with the addition of a point each for female sex and HIV serostatus (0.81 versus 0.73). Conclusions— ICH score at admission is a strong prognostic indicator of 30-day case fatality in Uganda. Our results support its role in guiding the care of patients presenting with ICH in the region.

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Predicting 30-Day Case Fatality of Primary Inoperable Intracerebral Hemorrhage Based on Findings at the Emergency Department

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2014.02.006 ◽

2014 ◽

Vol 23 (7) ◽

pp. 1928-1933 ◽

Cited By ~ 20

Author(s):

Panagiotis Zis ◽

Pavlos Leivadeas ◽

Dimitrios Michas ◽

Dimitrios Kravaritis ◽

Panagiotis Angelidakis ◽

...

Keyword(s):

Emergency Department ◽

Intracerebral Hemorrhage ◽

Case Fatality ◽

Day Case

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Temporal trends in early case-fatality rates in patients with intracerebral hemorrhage

Neurology ◽

10.1212/wnl.0000000000003681 ◽

2017 ◽

Vol 88 (10) ◽

pp. 985-990 ◽

Cited By ~ 21

Author(s):

Yannick Béjot ◽

Michael Grelat ◽

Benoit Delpont ◽

Jérôme Durier ◽

Olivier Rouaud ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Regression Models ◽

Temporal Change ◽

Cox Regression ◽

Temporal Trends ◽

Case Fatality ◽

Population Based ◽

Day Case ◽

Early Case ◽

Population Based Registry

Objective:To assess whether temporal trends in very early (within 48 hours) case-fatality rates may differ from those occurring between 48 hours and 30 days in patients with spontaneous intracerebral hemorrhage (ICH).Methods:All cases of ICH that occurred in Dijon, France (151,000 inhabitants), were prospectively collected between 1985 and 2011, using a population-based registry. Time trends in 30-day case fatality were analyzed in 3 periods: 1985–1993, 1994–2002, and 2003–2011. Cox regression models were used to evaluate associations between time periods and case fatality within 48 hours and between 48 hours and 30 days, after adjustments for demographics, risk factors, severity, and ICH location.Results:A total of 531 ICH cases were recorded (mean age 72.9 ± 15.8, 52.7% women). Thirty-day case fatality gradually decreased with time from 40.9% in 1985–1993 to 33.5% 1994–2002 and to 29.6% in 2003–2011 (adjusted hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.47–1.07, p = 0.106, for 1994–2002, and adjusted HR 0.49, 95% CI 0.32–0.73, p < 0.001, for 2003–2011). Over the whole study period, 43.6% of 1-month deaths occurred within the first 48 hours following ICH onset. There was no temporal change in case fatality occurring within the first 48 hours but a decrease in deaths occurring between 48 hours and 30 days was observed with time (HR 0.53, 95% CI 0.31–0.90, p = 0.02, for 1994–2002, and HR 0.32, 95% CI 0.32–0.55, p < 0.01, for 2003–2011, compared with 1985–1993).Conclusion:Although 30-day case fatality significantly decreased over the last 27 years, additional improvements in acute management of ICH are needed since very early case-fatality rates (within 48 hours) did not improve.

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