Plasma leptin level predicts hematoma growth and early neurological deterioration after acute intracerebral hemorrhage

Abstract Background Intracerebral hemorrhage (ICH) is caused by bleeding, primarily into parenchymal brain tissue, and accounts for 9 to 27% of all strokes worldwide. Higher neutrophils, lower lymphocytes, and higher neutrophil-to-lymphocytes ratio (NLR) values predict worse outcomes after spontaneous intracranial hemorrhage (sICH) and could aid in the risk stratification of patients. Methods Eighty patients with sICH within the first 24 h of stroke onset and admitted into the neurology intensive care unit of an Egyptian university hospital and were assessed by GCS for consciousness level and NIHSS for stroke severity assessment, complete blood count, and special attention to NLR. Patients were reevaluated by GCS and NIHSS on the 7th day of the stroke. Early neurological deterioration (END) was defined as four points or a greater increase in the NIHSS score or two points or a greater decrease in GCS or death. Results END was recorded in 21.25% of patients while non-END was recorded in 78.75%. END was highly significantly associated with a low grade of GCS, high grade of NIHSS, elevated absolute lymphocyte count (ALC), and elevated NLR. Lower GCS score, higher NIHSS score, larger hematoma volume, and higher NLR values were independent predictors for END. The best cutoff of NLR in END prediction was > 9.1. Conclusion NLR is a trustworthy early predictor of sICH outcome.

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Lower Treatment Blood Pressure Is Associated With Greatest Reduction in Hematoma Growth After Acute Intracerebral Hemorrhage

Hypertension ◽

10.1161/hypertensionaha.110.154328 ◽

2010 ◽

Vol 56 (5) ◽

pp. 852-858 ◽

Cited By ~ 52

Author(s):

Hisatomi Arima ◽

Craig S. Anderson ◽

Ji Guang Wang ◽

Yining Huang ◽

Emma Heeley ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Lower Treatment ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage

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Abstract 2276: Microhemorrhage Burden Increases the Risk of Hematoma Growth in Patients with Intracerebral Hemorrhage

Stroke ◽

10.1161/str.43.suppl_1.a2276 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Joan Martí-Fàbregas ◽

Estrella Morenas ◽

Raquel Delgado-Mederos ◽

Lavinia Dinia ◽

Esther Granell ◽

...

Keyword(s):

Differential Diagnosis ◽

Statistical Analysis ◽

Intracerebral Hemorrhage ◽

Multicentre Study ◽

Symptom Onset ◽

Variable Time ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage ◽

Radiological Studies

Introduction Microhemorrhages (MH) are lesions detected on radiological studies resulting from an underlying small-vessel angiopathy. We assesed the hypothesis that the presence of MH increases the risk of hematoma growth (HG) in patients with acute Intracerebral Hemorrhage (ICH). Methods We evaluated a series of patients in a prospective and multicentre study. We included patients with a spontaneous supratentorial ICH within the first 6 hours after symptom onset, that also had a follow-up CT 24-72 hours later and a MRI performed after a variable time after ICH. HG was defined as an increase >33% in the volume of hematoma on the follow-up CT, in comparison with the admission CT. The volume was calculated using the formula AxBxC/2. On MR scans we assessed the presence, number and distribution of MH. After differential diagnosis with other radiological lesions, MH were evaluated on echo-gradient sequences and defined as hypointense rounded lesions with a diameter <10mm. Statistical analysis: Bivariate tests with the whole sample and with the subgroup of patients with less than 3 hours from symptom onset. Results We studied 46 patients, whose mean age was 68.8±11.2 y and 68% were men. Mean baseline volume was 19.1±27.3 cc. We detected MH in 7/15 patients with HG and in 18/31 patients without HG (46.7% vs 58.1%, p=0.53). In the subgroup of patients with 10 MH, the risk of HG was higher than in patients with 0-10 MH (75% vs 28.6%, p=0.067), and this difference was significant when considering only patients with a <3 hours evolution (100% vs 31%, p=0.044). We did not observe any association between risk of HG and distribution of MH. Age and time to CT were equivalent in the two groups (with and without HG), either in the <6 or <3 hours subgroups. Conclusions In conclusion, in patients with hyperacute ICH, the presence of more than 10 MH increases the risk of HG. This is probably an indirect marker of a more severe underlying angiopathy.

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Predictors and Outcomes of Neurological Deterioration in Intracerebral Hemorrhage: Results from the TICH-2 Randomized Controlled Trial

Translational Stroke Research ◽

10.1007/s12975-020-00845-6 ◽

2020 ◽

Author(s):

Zhe Kang Law ◽

◽

Rob Dineen ◽

Timothy J England ◽

Lesley Cala ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Intracerebral Hemorrhage ◽

Tranexamic Acid ◽

Controlled Trial ◽

Neurological Deterioration ◽

Unique Identifier ◽

Risk Of Death ◽

Randomized Controlled ◽

Early Neurological Deterioration ◽

The Uk

Abstract Neurological deterioration is common after intracerebral hemorrhage (ICH). We aimed to identify the predictors and effects of neurological deterioration and whether tranexamic acid reduced the risk of neurological deterioration. Data from the Tranexamic acid in IntraCerebral Hemorrhage-2 (TICH-2) randomized controlled trial were analyzed. Neurological deterioration was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) of ≥ 4 or a decline in Glasgow Coma Scale of ≥ 2. Neurological deterioration was considered to be early if it started ≤ 48 h and late if commenced between 48 h and 7 days after onset. Logistic regression was used to identify predictors and effects of neurological deterioration and the effect of tranexamic acid on neurological deterioration. Of 2325 patients, 735 (31.7%) had neurological deterioration: 590 (80.3%) occurred early and 145 (19.7%) late. Predictors of early neurological deterioration included recruitment from the UK, previous ICH, higher admission systolic blood pressure, higher NIHSS, shorter onset-to-CT time, larger baseline hematoma, intraventricular hemorrhage, subarachnoid extension and antiplatelet therapy. Older age, male sex, higher NIHSS, previous ICH and larger baseline hematoma predicted late neurological deterioration. Neurological deterioration was independently associated with a modified Rankin Scale of > 3 (aOR 4.98, 3.70–6.70; p < 0.001). Tranexamic acid reduced the risk of early (aOR 0.79, 0.63–0.99; p = 0.041) but not late neurological deterioration (aOR 0.76, 0.52–1.11; p = 0.15). Larger hematoma size, intraventricular and subarachnoid extension increased the risk of neurological deterioration. Neurological deterioration increased the risk of death and dependency at day 90. Tranexamic acid reduced the risk of early neurological deterioration and warrants further investigation in ICH. URL:https://www.isrctn.com Unique identifier: ISRCTN93732214

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Earlier Blood Pressure-Lowering and Greater Attenuation of Hematoma Growth in Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.112.651422 ◽

2012 ◽

Vol 43 (8) ◽

pp. 2236-2238 ◽

Cited By ~ 22

Author(s):

Hisatomi Arima ◽

Yining Huang ◽

Ji Guang Wang ◽

Emma Heeley ◽

Candice Delcourt ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Blood Pressure Lowering ◽

Pressure Lowering ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage

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How Should We Lower Blood Pressure after Cerebral Hemorrhage? A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000462986 ◽

2017 ◽

Vol 43 (5-6) ◽

pp. 207-213 ◽

Cited By ~ 69

Author(s):

Simona Lattanzi ◽

Claudia Cagnetti ◽

Leandro Provinciali ◽

Mauro Silvestrini

Keyword(s):

Blood Pressure ◽

Cerebral Hemorrhage ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Incidence Rates ◽

Neurological Deterioration ◽

Hematoma Expansion ◽

Severe Hypotension ◽

Early Neurological Deterioration ◽

Hematoma Growth

Background: The optimal treatment of high blood pressure (BP) after acute intra-cerebral hemorrhage (ICH) is controversial. Summary: The aim of the study was to evaluate the safety and efficacy of early intensive vs. conservative BP lowering treatment in patients with ICH. Randomized controlled trials with active and control groups receiving intensive and conservative BP lowering treatments were identified. The following outcomes were assessed: 3-month mortality and combined death or major disability, 24-h hematoma growth, early neurological deterioration, occurrence of hypotension, severe hypotension, and serious treatment-emergent adverse events. Five trials were included involving 4,350 participants, 2,162 and 2,188 for intensive and conservative treatment groups, respectively. The pooled risk ratio of 3-month death or major disability was 0.96 (0.91-1.01) and the weighted mean difference in absolute hematoma growth was -1.53 (95% CI -2.94 to -0.12) mL in the intensive compared to conservative BP-lowering. There were no differences across the treatments in the incidence rates of 3-month mortality, early neurological deterioration, hypotension, and treatment-related adverse effects other than renal events. Key Messages: The early intensive anti-hypertensive treatment was overall safe and reduced the hematoma expansion in patients presenting with acute-onset spontaneous ICH and high BP levels.

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Correlation of leukocytosis with early neurological deterioration following supratentorial intracerebral hemorrhage

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2011.11.020 ◽

2012 ◽

Vol 19 (8) ◽

pp. 1096-1100 ◽

Cited By ~ 25

Author(s):

Wei Sun ◽

Amanda Peacock ◽

Jane Becker ◽

Barbara Phillips-Bute ◽

Daniel T. Laskowitz ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Neurological Deterioration ◽

Early Neurological Deterioration

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Abstract WP305: Impact of Potential Systolic Blood Pressure Treatment Thresholds on Hematoma Growth in Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.44.suppl_1.awp305 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

David Rodriguez-Luna ◽

Marta Rubiera ◽

Marian Muchada ◽

Pilar Coscojuela ◽

Marc Ribo ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Systolic Blood Pressure ◽

Statistical Significance ◽

Secondary Analysis ◽

Hematoma Enlargement ◽

Treatment Thresholds ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage ◽

The Impact

Background: Although the current AHA guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg in acute intracerebral hemorrhage (ICH), little is known about the relationships between different therapeutic target thresholds and hematoma growth (HG). Therefore, we aimed to investigate the impact of potential SBP treatment thresholds on HG in patients with acute ICH. Methods: This study was a secondary analysis of data prospectively collected during a previously reported study of the impact of blood pressure (BP) on HG in 106 patients with acute (<6 hours) supratentorial ICH. Patients underwent baseline and 24-hour computed tomography scans, and noninvasive BP monitoring at 15 minutes interval over first 24 hours. SBP loads were defined as the percentage of 24-hour SBP monitoring values exceeding 140, 150, 160, 170, 180, 190, and 200 mmHg. HG was defined as a relative enlargement greater than 33% or an absolute expansion more than 6 mL at 24 hours. Results: Patients who experienced HG (34%) presented higher SBP loads in all thresholds, reaching statistical significance in 170, 180, and 190 thresholds, but not in the others (Figure). Whilst SBP load thresholds were correlated neither with baseline nor 24-hour ICH volumes, highest (170 to 200) but not lowest (140 to 160) SBP load thresholds were significantly correlated with the amount of both relative and absolute hematoma enlargement at 24 hours (p<0.05). In multivariate analyses, both SBP 170-load (OR 1.034, 95% CI 1.001-1.070, p=0.048) and 180-load (OR 1.052, 95% CI 1.010-1.097, p=0.016) were independently related to HG. Conclusions: In patients with acute supratentorial ICH, those who experience HG present higher SBP load from 140 to 200 mmHg thresholds. More intensive SBP-lowering treatment than guidelines recommendations is needed, at least below 170 mmHg, in order to minimize the deleterious effect of higher SBP on HG.

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