Dataset Information

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

ABSTRACT:

Background

Previous studies have suggested that elevated neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) may be associated with poor outcomes in intracerebral hemorrhage (ICH). We sought to determine whether white blood cell (WBC) types were independently associated with poor outcome in ICH in a large cohort.

Methods

We performed a retrospective study of primary ICH at two academic centers. Cases were identified via ICD-9 code and verified via physician review. We included only those patients with WBC types obtained within 24 h of ICH onset.

Results

We identified 593 patients with primary ICH and WBC differentials in the first 24 h. Independent factors (OR, 95% CI) associated with 30-day case fatality were age > 80 (2.4 (1.4, 4.2)), p = 0.0023; NIHSS greater than median (3.9 (2.4, 6.3)), p < 0.0001; ICH volume quartiles (Q1: ref, Q2: 1.5 (0.7, 3.0), Q3: 3.2 (1.6, 6.6), Q4: 11.9 (5.3, 26.4)), p < 0.0001; non-lobar location (3.3 (1.9, 5.9)), p ≤ 0.0001; IVH (2.3 (1.4, 3.6)), p = 0.0005, monocytes greater than median (1.6 (1.0, 2.4)), p = 0.0457, and anticoagulant use (3.2 (1.8, 5.6)), p < 0.0001. Elevated NLR was not associated with higher case fatality.

Conclusions

We found that elevated monocytes were independently associated with 30-day case fatality. Future studies will investigate whether there are subgroups of ICH patients, including those with particular blood or imaging biomarkers, in which WBC types might help predict poor outcome and provide targets for intervention.

SUBMITTER: Mackey J

PROVIDER: S-EPMC7791001 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

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

Mackey Jason J Blatsioris Ashley D AD Saha Chandan C Moser Elizabeth A S EAS Carter Ravan J L RJL Cohen-Gadol Aaron A AA Leipzig Thomas J TJ Williams Linda S LS

Neurocritical care 20210401 2

<h4>Background</h4>Previous studies have suggested that elevated neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) may be associated with poor outcomes in intracerebral hemorrhage (ICH). We sought to determine whether white blood cell (WBC) types were independently associated with poor outcome in ICH in a large cohort.<h4>Methods</h4>We performed a retrospective study of primary ICH at two academic centers. Cases were identified via ICD-9 code and verified via physician review. We ...[more]

PMID: 32642966

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Project description:Background and purposeInfections are common after intracerebral hemorrhage, but little is known about the risk of serious infection requiring readmission after hospital discharge.MethodsTo determine if infections are prevalent in patients readmitted within 30 days of discharge, we performed a retrospective cohort study of patients discharged from nonfederal acute care hospitals in California with a primary diagnosis of intracerebral hemorrhage between 2006 and 2010. We excluded patients who died during the index admission, were discharged against medical advice, or were not California residents. Our main outcome was 30-day unplanned readmission with primary infection-related International Classification of Diseases, Ninth Revision, Clinical Modification code.ResultsThere were 24 540 index intracerebral hemorrhage visits from 2006 to 2010. Unplanned readmissions occurred in 14.5% (n=3550) of index patients. Of 3550 readmissions, 777 (22%) had an infection-related primary diagnosis code. When evaluating primary and all secondary diagnosis codes, infection was associated with 1826 (51%) of readmissions. Other common diagnoses associated with readmission included stroke-related codes (n=840, 23.7%) and aspiration pneumonitis (n=154, 4.3%). The most common infection-related primary diagnosis codes were septicemia (n=420, 11.8%), pneumonia (n=124, 3.5%), urinary tract infection (n=141, 4.0%), and gastrointestinal infection (n=42, 1.2%). Patients with a primary infection-related International Classification of Diseases, Ninth Revision, Clinical Modification code on readmission had higher in-hospital mortality compared with other types of readmission (15.6% versus 8.0%, P<0.001). After controlling for other predictors of mortality, primary infection-related readmissions remained associated with in-hospital mortality (relative risk, 1.7; 95% confidence interval, 1.3-2.2).ConclusionsInfections are associated with a majority of 30-day readmissions after intracerebral hemorrhage and increased mortality. Efforts should be made to reduce infection-related complications after hospital discharge.

Project description:BackgroundIntracerebral hemorrhage (ICH) is a stroke syndrome with an unfavorable prognosis. Currently, there is no comprehensive clinical indicator for mortality prediction of ICH patients. The purpose of our study was to construct and evaluate a nomogram for predicting the 30-day mortality risk of ICH patients.MethodsICH patients were extracted from the MIMIC-III database according to the ICD-9 code and randomly divided into training and verification cohorts. The least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression were applied to determine independent risk factors. These risk factors were used to construct a nomogram model for predicting the 30-day mortality risk of ICH patients. The nomogram was verified by the area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA).ResultsA total of 890 ICH patients were included in the study. Logistic regression analysis revealed that age (OR = 1.05, P < 0.001), Glasgow Coma Scale score (OR = 0.91, P < 0.001), creatinine (OR = 1.30, P < 0.001), white blood cell count (OR = 1.10, P < 0.001), temperature (OR = 1.73, P < 0.001), glucose (OR = 1.01, P < 0.001), urine output (OR = 1.00, P = 0.020), and bleeding volume (OR = 1.02, P < 0.001) were independent risk factors for 30-day mortality of ICH patients. The calibration curve indicated that the nomogram was well calibrated. When predicting the 30-day mortality risk, the nomogram exhibited good discrimination in the training and validation cohorts (C-index: 0.782 and 0.778, respectively). The AUCs were 0.778, 0.733, and 0.728 for the nomogram, Simplified Acute Physiology Score II (SAPSII), and Oxford Acute Severity of Illness Score (OASIS), respectively, in the validation cohort. The IDI and NRI calculations and DCA analysis revealed that the nomogram model had a greater net benefit than the SAPSII and OASIS scoring systems.ConclusionThis study identified independent risk factors for 30-day mortality of ICH patients and constructed a predictive nomogram model, which may help to improve the prognosis of ICH patients.

Project description:BackgroundNoncontrast computed tomography (NCCT) is often performed for patients with a suspected spontaneous intracerebral hemorrhage (ICH) at the time of admission. Both clinical and radiomic features on the initial NCCT can predict the outcomes of those with ICH, but satisfactory model performance remains challenging.MethodsA total of 258 acute ICH patients from the Central Hospital of Wuhan (CHW) between January 2018 and December 2020 were retrospectively assigned to training and internal validation cohorts at a ratio of 7:3. An independent external testing cohort of 87 patients from January 2021 to July 2021 from the Fifth Affiliated Hospital of Nanchang University (FAHNU) was also used. Based on the least absolute shrinkage and selection operator (LASSO) algorithm, radiomics (rad)-scores were generated from 9 quantitative features on the initial NCCT images. Three models (radiomics, clinical, and hybrid) were established using stepwise logistic regression analysis. The Akaike information criterion and the likelihood ratio test were used to compare the goodness of fit of the three models. Receiver operating characteristic (ROC) curve analysis was performed and bar charts were constructed to evaluate the discrimination of constructed model for predicting a poor outcome following ICH.ResultsThe three cohorts had similar baseline clinical characteristics, including demographic features and outcomes. In the clinical model, hematoma expansion [2.457 (0.297, 2.633); P=0.014], intracerebral ventricular hemorrhage [2.374 (0.180, 1.882); P=0.018], and location [-2.268 (-2.578, -0.188); P=0.023] were independently associated with a poor clinical outcome. In the hybrid model, location [-2.291 (-2.925, -0.228); P=0.022], and rad-score [5.255 (0.680, 11.460); P<0.001] were independently associated with a poor outcome. The hybrid model achieved satisfactory discriminability, with areas under curve (AUCs) of 0.892 [95% confidence interval (CI): 0.847 to 0.937], 0.893 (95% CI: 0.820 to 0.966), and 0.838 (95% CI: 0.755 to 0.920) in the training, internal validation, and external testing cohorts, respectively. The hybrid model also achieved good discriminability in the prediction of 30-day mortality, with AUCs of 0.840, 0.823, and 0.883 in the training, internal validation, and external testing cohorts, respectively. The rad-score [2.861 (1.940, 4.220); P<0.001] was the predominant risk factor associated with 30-day mortality.ConclusionsRadiomic analysis based on initial NCCT scans showed added value in predicting a poor outcome after ICH. A clinical-radiomics model yielded improved accuracy in predicting a poor outcome and 30-day death following ICH compared with radiomics alone.

Project description:PurposeRadical cystectomy/urinary diversion is a high risk procedure. Intraoperative stents are commonly utilized to decrease ureteroenteric anastomosis related complications. Institutionally some surgeons routinely use intraoperative stents while others do not, providing an opportunity to compare complication differences.Materials and methodsWe queried a prospective database of 283 patients enrolled in a randomized controlled trial evaluating 30-day perioperative complications with goal directed fluid therapy following open radical cystectomy/urinary diversion between 2014 and 2018. Ureteroenteric anastomosis specific complications (ureteral obstruction, urinary leak, urinary infections/sepsis and intra-abdominal abscess) were compared between groups (intraoperative stent vs nonintraoperative stent group) using Fisher exact test and quantified using logistic regression.ResultsThe nonintraoperative stent group (77 of 283 patients, 27%) was older (median 72 vs 69 years) and was more likely to receive neoadjuvant chemotherapy (53% vs 40%), have baseline renal insufficiency (43% vs 30%) and undergo an ileal conduit (92% vs 53%). However, despite higher comorbidity, the nonintraoperative stent group had a significantly lower rate of ureteroenteric anastomosis complications (14% vs 32%, p=0.004). Since continent diversions may be associated with higher complications, the nonintraoperative stent group with ileal conduit was also compared to intraoperative stent cohorts with ileal conduit, and ureteroenteric anastomosis complications remained lower in the nonintraoperative stent group (14% vs 28%, p=0.043). Multivariable logistic regression showed significantly increased odds of urinary complications with intraoperative stent use (OR 3.55, 95% CI 2.93-4.31; p <0.0001). Importantly there was no obstruction and only 1 leak (1.3%) in the nonintraoperative stent group.ConclusionsContrary to conventional belief, we found intraoperative stent use in radical cystectomy/urinary diversion was associated with significantly higher infectious complications and urgent care visits, and significantly increased the odds of 30-day ureteroenteric anastomosis associated complications.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

Similar Datasets

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