3 research outputs found
Supplementary Material for: Functional Long-Term Outcome after Left- versus Right-Sided Intracerebral Hemorrhage
<p><b><i>Background and Purpose:</i></b> Hemispheric location might
influence outcome after intracerebral hemorrhage (ICH). INTERACT
suggested higher short-term mortality in right hemispheric ICH, yet
statistical imbalances were not addressed. This study aimed at
determining the differences in long-term functional outcome in patients
with right- vs. left-sided ICH with a priori-defined sub-analysis of
lobar vs. deep bleedings. <b><i>Methods:</i></b> Data from a prospective
hospital registry were analyzed including patients with ICH admitted
between January 2006 and August 2014. Data were retrieved from
institutional databases. Outcome was assessed using the modified Rankin
Scale (mRS) score. Outcome measures (long-term mortality and functional
outcome at 12 months) were correlated with ICH location and hemisphere,
and the imbalances of baseline characteristics were addressed by
propensity score matching. <b><i>Results:</i></b> A total of 831
patients with supratentorial ICH (429 left and 402 right) were analyzed.
Regarding clinical baseline characteristics in the unadjusted overall
cohort, there were differences in disfavor of right-sided ICH
(antiplatelets: 25.2% in left ICH vs. 34.3% in right ICH; <i>p</i> < 0.01; previous ischemic stroke: 14.7% in left ICH vs. 19.7% in right ICH; <i>p</i> = 0.057; and presence/extent of intraventricular hemorrhage: 45.0% in left ICH vs. 53.0% in right ICH; <i>p</i> = 0.021; Graeb-score: 0 [0-4] in left ICH vs. 1 [0-5] in right ICH; <i>p</i>
= 0.017). While there were no differences in mortality and in the
proportion of patients with favorable vs. unfavorable outcome (mRS 0-3:
142/375 [37.9%] in left ICH vs. 117/362 [32.3%] in right ICH; <i>p</i> =
0.115), patients with left-sided ICH showed excellent outcome more
frequently (mRS 0-1: 64/375 [17.1%] in left ICH vs. 43/362 [11.9%] in
right ICH; <i>p</i> = 0.046) in the unadjusted analysis. After adjusting for confounding variables, a well-balanced group of patients (<i>n</i>
= 360/hemisphere) was compared showing no differences in long-term
functional outcome (mRS 0-3: 36.4% in left ICH vs. 33.9% in right ICH; <i>p</i>
= 0.51). Sub-analyses of patients with deep vs. lobar ICH revealed also
no differences in outcome measures (mRS 0-3: 53/151 [35.1%] in left
deep ICH vs. 53/165 [32.1%] in right deep ICH; <i>p</i> = 0.58). <b><i>Conclusion:</i></b>
Previously described differences in clinical end points among patients
with left- vs. right-hemispheric ICH may be driven by different baseline
characteristics rather than by functional deficits emerging from
different hemispheric functions affected. After statistical corrections
for confounding variables, there was no impact of hemispheric location
on functional outcome after ICH.</p
Supplementary Material for: Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage
<p><b><i>Background and Purpose:</i></b> Stroke-associated
immunosuppression and inflammation are increasingly recognized as
factors that trigger infections and thus, potentially influence the
outcome after stroke. Several studies demonstrated that elevated
neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of
adverse outcomes in patients with ischemic stroke. However, little is
known about the impact of NLR on short-term mortality in intracerebral
hemorrhage (ICH). <b><i>Methods:</i></b> This observational study
included 855 consecutive ICH-patients. Patient demographics, clinical,
laboratory, and in-hospital measures as well as neuroradiological data
were retrieved from institutional databases. Functional 3-months-outcome
was assessed and categorized as favorable (modified Rankin Scale [mRS]
0-3) and unfavorable (mRS 4-6). We (i) studied the natural course of NLR
in ICH, (ii) analyzed parameters associated with NLR on admission
(NLROA), and (iii) evaluated the clinical impact of NLR on mortality and
functional outcome. <b><i>Results:</i></b> The median NLROA of the
entire cohort was 4.66 and it remained stable during the entire hospital
stay. Patients with NLR ≥4.66 showed significant associations with
poorer neurological status (National Institute of Health Stroke Scale
[NIHSS] 18 [9-32] vs. 10 [4-21]; <i>p</i> < 0.001), larger hematoma volume on admission (17.6 [6.9-47.7] vs. 10.6 [3.8-31.7] mL; <i>p</i> = 0.001), and more frequently unfavorable outcome (mRS 4-6 at 3 months: 317/427 [74.2%] vs. 275/428 [64.3%]; <i>p</i>
= 0.002). Patients with an NLR under the 25th percentile (NLR
<2.606) - compared to patients with NLR >2.606 - presented with a
better clinical status (NIHSS 12 [5-21] vs. 15 [6-28]; <i>p</i> = 0.005), lower hematoma volumes on admission (10.6 [3.6-30.1] vs. 15.1 [5.7-42.3] mL; <i>p</i> = 0.004) and showed a better functional outcome (3 months mRS 0-3: 82/214 [38.3%] vs. 185/641 [28.9%]; <i>p</i>
= 0.009). Patients associated with high NLR (≥8.508 = above
75th-percentile) showed the worst neurological status on admission
(NIHSS 21 [12-32] vs. 12 [5-23]; <i>p</i> < 0.001), larger hematoma volumes (21.0 [8.6-48.8] vs. 12.2 [4.1-34.9] mL; <i>p</i> < 0.001), and higher proportions of unfavorable functional outcome at 3 months (mRS 4-6: 173/214 vs. 418/641; <i>p</i> < 0.001). Further, NLR was linked to more frequently occurring infectious complications (pneumonia 107/214 vs. 240/641; <i>p</i> = 0.001, sepsis: 78/214 vs. 116/641; <i>p</i> < 0.001), and increased c-reactive-protein levels on admission (<i>p</i> < 0.001; <i>R</i><sup>2</sup>
= 0.064). Adjusting for the above-mentioned baseline confounders,
multivariable logistic analyses revealed independent associations of
NLROA with in-hospital mortality (OR 0.967, 95% CI 0.939-0.997; <i>p</i> = 0.029). <b><i>Conclusions:</i></b>
NLR represents an independent parameter associated with increased
mortality in ICH patients. Stroke physicians should focus intensely on
patients with increased NLR, as these patients appear to represent a
population at risk for infectious complications and increased
short-mortality. Whether these patients with elevated NLR may benefit
from a close monitoring and specially designed therapies should be
investigated in future studies.</p
Supplementary Material for: Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage
<p><b><i>Background:</i></b> Data on clinical characteristics and
outcome of patients with intracerebral hemorrhage (ICH) and concomitant
systemic cancer disease are very limited. <b><i>Methods:</i></b> Nine
hundred and seventy three consecutive primary ICH patients were analyzed
using our prospective institutional registry over a period of 9 years
(2006-2014). We compared clinical and radiological parameters as well as
outcome - scored using the modified Rankin Scale (mRS) and analyzed in a
dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable
outcome (mRS = 4-6) - of ICH patients with and without cancer. Relevant
imbalances in baseline clinical and radiological characteristics were
adjusted using propensity score (PS) matching. <b><i>Results:</i></b>
Prevalence of systemic cancer among patients with ICH was 8.5% (83/973).
ICH patients with cancer were older (77 [70-82] vs. 72 [63-80] years; <i>p</i> = 0.002), had more often prior renal dysfunction (19/83 [22.9%] vs.107/890 [12.0%]; <i>p</i> = 0.005), and smaller hemorrhage volumes (10.1 [4.8-24.3] vs. 15.3 [5.4-42.9] mL; <i>p</i>
= 0.017). After PS-matching there were no significant differences
neither in mortality nor in functional outcome both at 3 months
(mortality: 33/81 [40.7%] vs. 55/158 [34.8%]; <i>p</i> = 0.368; mRS = 0-3: 28/81 [34.6%] vs. 52/158 [32.9%]; <i>p</i> = 0.797) and 12 months (mortality: 39/78 [50.0%] vs. 70/150 [46.7%]; <i>p</i> = 0.633; mRS = 0-3: 25/78 [32.1%] vs. 53/150 [35.3%]; <i>p</i>
= 0.620) among patients with and without concomitant systemic cancer.
ICH volume tended to be highest in patients with hematooncologic
malignancy and smallest in urothelial cancer. <b><i>Conclusions:</i></b>
Patients with ICH and concomitant systemic cancer on average are older;
however, they show smaller ICH volumes compared to patients without
cancer. Yet, mortality and functional outcome is not different in ICH
patients with and without cancer. Thus, the clinical history or the de
novo diagnosis of concomitant malignancies in ICH patients should not
lead to unjustified treatment restrictions.</p