scholarly journals Effectiveness of neutrophil/lymphocyte, lymphocyte/MPV and platelet/MPV ratios in the classification and mortality prediction of acute stroke

2021 ◽  
Vol 8 (2) ◽  
pp. 122-127
Author(s):  
Suna Eraybar ◽  
Melih Yuksel

Objective: The aim of this study is to investigate whether Neutrophil / lymphocyte (NLR), Lymphocyte / MPV (mean platelet volume)  (LMR) and thrombocyte / MPV (PMR) ratios obtained from the complete blood count, can be used as an effective marker in acute stroke for determining the prognosis and subtype of stroke. Material and methods: Patients admitted to the emergency department with acute stroke symptoms between January 1, 2020 and December 31, 2020 were evaluated retrospectively. The patients were divided into two groups as hemorrhagic or ischemic cerebrovascular disease (CVD) according to the radiological findings. NLR, LMR and PMR ratios were calculated. The last diagnosis and hospitalization information were recorded and their 28-day mortality status was evaluated. Results: A total of 764 patients were included in the study. The median age of the patients included in the study was 68 (IQR 25-75: 59-78) and 404 (52.9%) of the patients were male. In the analysis performed; it was observed that the LMR, NLR and PMR levels were significantly different in those who developed mortality on the 28th day (p = 0.009), (p = 0.002), (p = 0.026). In addition, only the NLR level was found to be significantly different in the ischemic group (p <0.001). Conclusion: We think that in cases with stroke, NLR, LMR and PMR levels can be used in predicting the prognosis of this disease. Also, NLR is significantly higher in ischemic stroke, and also significant in terms of showing that CVD type is hemorrhagic or ischemic.

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nicolle W Davis ◽  
Meghan Bailey ◽  
Natalie Buchwald ◽  
Amreen Farooqui ◽  
Anna Khanna

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.


2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.


2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Mattia Bellan ◽  
Danila Azzolina ◽  
Eyal Hayden ◽  
Gianluca Gaidano ◽  
Mario Pirisi ◽  
...  

Introduction. The clinical course of Coronavirus Disease 2019 (COVID-19) is highly heterogenous, ranging from asymptomatic to fatal forms. The identification of clinical and laboratory predictors of poor prognosis may assist clinicians in monitoring strategies and therapeutic decisions. Materials and Methods. In this study, we retrospectively assessed the prognostic value of a simple tool, the complete blood count, on a cohort of 664 patients ( F 260; 39%, median age 70 (56-81) years) hospitalized for COVID-19 in Northern Italy. We collected demographic data along with complete blood cell count; moreover, the outcome of the hospital in-stay was recorded. Results. At data cut-off, 221/664 patients (33.3%) had died and 453/664 (66.7%) had been discharged. Red cell distribution width (RDW) ( χ 2 10.4; p < 0.001 ), neutrophil-to-lymphocyte (NL) ratio ( χ 2 7.6; p = 0.006 ), and platelet count ( χ 2 5.39; p = 0.02 ), along with age ( χ 2 87.6; p < 0.001 ) and gender ( χ 2 17.3; p < 0.001 ), accurately predicted in-hospital mortality. Hemoglobin levels were not associated with mortality. We also identified the best cut-off for mortality prediction: a NL   ratio > 4.68 was characterized by an odds ratio for in-hospital mortality   OR = 3.40 (2.40-4.82), while the OR for a RDW > 13.7 % was 4.09 (2.87-5.83); a platelet   count > 166,000 /μL was, conversely, protective (OR: 0.45 (0.32-0.63)). Conclusion. Our findings arise the opportunity of stratifying COVID-19 severity according to simple lab parameters, which may drive clinical decisions about monitoring and treatment.


2016 ◽  
Vol 22 (1) ◽  
Author(s):  
Kerem Doğa Seçkin ◽  
Mehmet Fatih Karslı ◽  
Burak Yücel ◽  
Elif Akkaş Yılmaz ◽  
Murat Öz ◽  
...  

<p>OBJECTIVE: The aim of the study was to determine whether it is possible to differentiate submucosal fibroids before interventional procedures based on mean platelet volume (MPV), in reproductive-age patients presenting with endometrial thickening and abnormal uterine bleeding.<br />STUDY DESIGN: This study included 581 reproductive-age women who underwent diagnostic procedures (curettage or operative hysteroscopy) and were subsequently divided into two groups based on clinico-pathological findings. The first group included those with benign endometrial pathology (control group, n=438), and the second group consisted of those with submucosal leiomyomas (n=143). The demographic characteristics and complete blood count (CBC) data of these patients were collected retrospectively, and comparisons were made between groups.<br />RESULTS: No statistically significant difference was found between the groups according to demographic features and CBC parameters such as hemoglobin levels and white blood count (p&gt;0,05). Platelet counts were significantly higher and MPV values were significantly lower in submucosal leiomyoma patients compared with the control subjects (p&lt;0,05).<br />CONCLUSIONS: MPV may be a useful predictive marker when differentiating submucosal leiomyoma from other benign causes of abnormal uterine bleeding. The ability to predict the possibility of the presence of submucosal leiomyoma before surgery can assist in determining the most appropriate type of invasive procedure.</p>


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4619-4619
Author(s):  
Yan Zheng ◽  
Guangyuan Li ◽  
Menglei Zhu ◽  
Yu Li ◽  
Howard Meyerson ◽  
...  

Abstract Cellular prion protein (PrPC) is a GPI-anchored cell surface glycoprotein that is expressed in the brain, blood, bone marrow (BM), and lymphoid tissue. PrPC can be converted post-translationally into scrapie-PrP (PrPSc), which is involved in the pathogenesis of neurodegenerative diseases including Creutzfeldt-Jakob disease, Kuru disease in humans, and scrapie and bovine spongiform encephalopathy in animals. However, the biological function of PrPSc has yet to be conclusively elucidated. In order to understand the role of PrPC in the hematopoietic system, we compared bone marrow, lymphoid organs and peripheral blood of PrPC knockout mice (KO) to age and sex-matched transgenic mice used as background controls (WT) expressing human PrPC under the control of a mouse PrPC promoter with a slightly augmented expression (2-fold) of PrPC. Complete blood count (CBC) showed a significant increase of WBC in KO mice (KO 9.03 ± 5.16 x109/L vs. WT 4.13 ± 1.87 x109/L, p = 0.0405; Table 1 and Figure 1). Further analysis of WBC differential revealed that the elevated number of WBC in KO mice was due to lymphocytosis. Specifically, KO mice had a 3-fold increase in the absolute lymphocyte count (KO 7.59 ± 4.63 x109/L vs. WT 2.90 ± 1.32 x109/L, p = 0.0303), as well as a higher lymphocyte percentage (KO 82.47 ± 4.20% vs. WT 70.19 ± 4.44%, p = 0.0011) compared to controls. KO mice also had a trend toward higher hemoglobin (KO 12.00 ± 4.40 g/dL vs. WT 9.84 ± 4.83 g/dL), RBC (KO 8.01 ± 2.87 x1012/L vs. WT 6.25 ± 3.11 x1012/L), and hematocrit (KO 43.94 ± 17.00 % vs. WT 36.04 ± 18.07 %) compared to WT mice. Additionally, platelet count in KO mice was higher than control mice (KO 762.20 ± 138.61 x 109/L vs. WT 661.80 ± 230.20 x 109/L). Of interest, the mean platelet volume (platelet size) was significantly increased in KO mice compared to controls (KO 6.00 ± 0.29 fL vs. WT 5.24 ± 0.56 fL, p =0.0140). Thus, absence of PrPC resulted in significant leukocytosis and specifically higher absolute count and percentage of lymphocytes, as well as larger platelets in peripheral blood. To further analyze if the observed lymphocytosis is due to abnormalities in hematopoiesis or lymphopoiesis, bone marrow (BM), thymus, spleen and lymph nodes from WT and KO mice were isolated and examined by flow cytometry using a comprehensive panel of fluorochrome-conjugated antibodies specific for all hematologic cell precursors/lineages. Analysis of all cell populations in each of these organs revealed no significant differences in the numbers of RBC and megakaryocyte in BM, and of lymphocytes in the thymus, spleen and lymph nodes (data no shown). Additionally, histological analysis of BM, thymus, spleen and lymph nodes tissue from KO and WT animals failed to show morphological differences between the two groups (data not shown). Therefore, lack of PrPC does not appear to affect hematopoiesis and lymphopoiesis. In summary, our findings indicate that PrPC deficiency translates into a significant increase in the number of lymphocytes in peripheral blood; however, development and maturation of lymphocytes in KO mice appeared normal. Therefore, PrPC might be critical in the survival and trafficking of lymphocytes in peripheral blood. The molecular mechanisms underlying the observed changes in lymphocytes and platelets, and whether there are any related changes in the functions of lymphocytes and platelets will be subject of future studies. Table 1. Complete blood count (CBC) of PrPC WT and KO mice WT KO p value Mean ± SD Mean ± SD WBC (109/L) 4.13 ± 1.87 9.03 ± 5.16 0.0405 Absolute lymphocyte count (109/L) 2.90 ± 1.32 7.59 ± 4.63 0.0303 Lymphocyte (%) 70.19 ± 4.44 82.47 ± 4.20 0.0011 RBC (1012/L) 6.25 ± 3.11 8.01 ± 2.87 0.1898 HB (g/dL) 9.84 ± 4.83 12.00 ± 4.40 0.2404 HCT (%) 36.04 ± 18.07 43.94 ± 17.00 0.2618 PLT (109/L) 661.80 ± 230.20 762.20 ± 138.61 0.2138 MPV (fL) 5.24 ± 0.56 6.00 ± 0.29 0.0140 SD: Standard deviation; WBC: White blood cell; RBC: Red blood cell; HB: Hemoglobin; HCT: Hematocrit; RDW: Red cell distribution width; PLT: Platelet; MPV: Mean platelet volume Figure 1. PrPC deficiency results in lymphocytosis in peripheral blood. Figure 1. PrPC deficiency results in lymphocytosis in peripheral blood. Disclosures No relevant conflicts of interest to declare.


Author(s):  
Zehra Vural Yılmaz ◽  
Elif Yılmaz ◽  
Bilal İçer ◽  
Tuncay Küçüközkan

<p><strong>Objective:</strong> The aim of this study is to evaluate the relationship between hematological changes in early pregnancy using complete blood count parameters and gestational diabetes mellitus.<br /><strong>Study Design:</strong> One hundred pregnant with gestational diabetes mellitus and one hundred healthy pregnant were included in the study. Blood samples for routine complete blood count parameters in first trimester of pregnancy were analyzed. <br /><strong>Results:</strong> In the gestational diabetes mellitus group white blood cell, platelet count, neutrophil and lymphocyte count, mean platelet volume, red cell distribution width were significantly higher than control group. However, there was no significant difference between groups with regard to neutrophil to lymphocyte ratio and platelet to lymphocyte ratio levels. In binary logistic regression analysis; first trimester mean platelet volume and red cell distribution width values were found to be independently associated with diagnosis of gestational diabetes mellitus. <br /><strong>Conclusion:</strong> This study demonstrates that hematological parameters in first trimester of pregnancy are closely associated with gestational diabetes mellitus. The parameters that are routinely and automatically calculated in complete blood count; may be used to predict gestational diabetes mellitus.</p>


Diagnosis and treatment of acute stroke has advanced considerably in the past 2 decades. Most notably, in cases of ischemic stroke, intravenous alteplase has become the standard of medical treatment despite its multiple contraindications and limited time window. More recently, trials have proven that endovascular thrombectomy is superior to medical therapy alone, advancing the standard of care for patients who present with acute ischemic stroke from a large vessel occlusion and salvageable brain tissue. The treatment of hemorrhagic stroke now involves the use of novel pharmacological agents and advanced minimally invasive technology. Important changes have also occurred at the levels of hospital organization and treatment decision-making. Such changes in organization and designation of hospitals with distinct levels of stroke care and the variety of stroke protocols now requires team work of emergency medical services (EMS), Emergency Department, stroke neurologists, neurosurgeons, and neurointerventionalists. This book provides an overview of the modern medical and surgical options for the treatment of patients with acute ischemic and hemorrhagic strokes. The pivotal role of EMS in prehospital evaluation and triage of a stroke patient and the levels of stroke systems of care are discussed. In addition, the current guidelines on the management of acute stroke, with the focus on early care of acute stroke patients at the Emergency Department and the first 24 hours of hospital admission, are reviewed. Each chapter contains a discussion of common clinical scenarios including initial management steps, practical points, and common pitfalls.


2006 ◽  
Vol 12 (3) ◽  
pp. 134-138 ◽  
Author(s):  
Karen Vroonhof ◽  
Wouter Van Solinge ◽  
Maroeska Rovers ◽  
Albert Huisman

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