Özge ÖCEK, Pınar ORTAN, Birdal GÜLLÜPINAR, E. Erol ÜNLÜLER, Serhat KORAN

TROMBOLİTİK TEDAVİ ALAN AKUT İSKEMİK İNMELİ HASTALARDA MORTALİTEYİ TAHMİN ETMEDE ÇEKİRDEKLİ KIRMIZI KAN HÜCRESİ, OLGUNLAŞMAMIŞ GRANÜLOSİT SAYISI VE YÜZDESİNİN ROLÜ

Giriş: İnme, dünyada ikinci en büyük ölüm nedenidir. Aynı zamanda dünya çapında engelliliğin önde gelen nedenidir. Bu çalışmanın amacı; akut iskemik inme (AIS) nedeniyle intravenöz trombolitik tedavi (IVT) alan hastalarda kısa vadeli mortaliteyi tahmin etmede çekirdekli kırmızı kan hücresi (NRBC), immatur granülosit sayı (IGS) ve yüzdesi (%IG)’nin etkili bir prediktif belirteç olup olmadığını araştırmayı amaçladık. Gereç ve Yöntem: Ocak 2021-Ekim 2021 tarihleri arasında IVT alan AIS hastalar retrospektif olarak tarandı. Bu hastalar yaş, cinsiyet, inme risk faktörleri, Ulusal Sağlık Enstitüleri İnme Ölçeği (NIHSS), acil servise başvuru anında beyaz kan hücresi, NRBC, IGS ve %IG parametreleri kaydedildi. Mortalite gelişen ve gelişmeyen grup olmak üzere ikiye ayrıldı. Birincil sonuç, 1 aylık mortaliteyi içermesidir. İkincil sonuç ise semptomatik intrakraniyal kanamadır. Bulgular: Çalışmamıza acil serviste IVT uyguladığımız 61 hastadan 51’i dahil edildi. Hastaların 13’ünde (%25,5) takip sırasında mortalite gelişti. NRBC ortalaması mortalite gelişen hastalarda 0,35±0,27 iken, mortalite gelişmeyen hastalarda ise 0,01±0,05 olarak bulundu. IG ortalaması mortalite gelişen hastalarda 0,20±0,16 iken, mortalite gelişmeyen hastalarda 0,04±0,03 idi. Hem NRBC hem de IG istatiksel olarak anlamlıydı. Ayrıca iki hastada intraparankimal kanama gözlendi. Sonuç: Çalışmamız IVT ile tedavi edilen AIS hastalarında periferik kanda artmış NRBC, % IG ve IGS değerleri mortalitenin erken bir biyobelirteci olabilir.

THE ROLE OF NUCLEATED RED BLOOD CELL, IMMATURE GRANULOCYTE COUNT AND PERCENTAGE IN PREDICTING MORTALITY IN PATIENTS WITH ACUTE ISCHEMIC STROKE RECEIVING THROMBOLYTIC THERAPY

Introduction: Stroke is the second leading cause of death in the world. It is also the leading cause of disability worldwide. The aim of this study; we aimed to investigate whether an effective predictive marker of nucleated red blood cell (NRBC), immature granulocyte count (IGC), and percent (IG%) in predicting short-term mortality in patients receiving intravenous thrombolytic therapy (IVT) for acute ischemic stroke (AIS). Material and Method: AIS patients who received IVT between January 2021 and October 2021 were retrospectively screened. Age, gender, stroke risk factors, National Institutes of Health Stroke Scale (NIHSS), white blood cell, NRBC, IGS and %IG parameters at the time of admission to the emergency department were recorded in these patients. Mortality was divided into developing and non-developing groups. The primary outcome is that it includes 1-month mortality. The secondary outcome is symptomatic intracranial hemorrhage. Results: 51 of 61 patients who underwent IVT in the emergency department were included in our study. Mortality developed in 13 (25.5%) patients during follow-up. While the mean NRBC was 0.35±0.27 in patients who developed mortality, it was 0.01±0.05 in patients who did not develop mortality. While the mean of IG was 0.20±0.16 in patients who developed mortality, it was 0.04±0.03 in patients who did not develop mortality. Both NRBC and IG were statistically significant. In addition, intraparenchymal hemorrhage was observed in two patients Conclusion: In our study, increased NRBC, % IG and IGS values in peripheral blood may be an early biomarker of mortality in AIS patients treated with IVT

PDF

___

1. Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat 2018;3238165.
2. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991; 337(8756): 1521-6.
3. Jin R, Yang G, Li G. Inflammatory mechanisms in ischemic stroke: role of inflammatory cells. J Leukoc Biol 2010; 87(5): 779-89.
4. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al. American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ıschemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49(3): e46-e110.
5. Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M et al. European Stroke Organisation (ESO)- European Society for minimally ınvasive neurological therapy (esmınt) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg 2019; 11(6): 535-8.
6. Menon BK, Al-Ajlan FS, Najm M, Puig J, Castellanos M, Dowlatshahi D et al. INTERRSeCT Study Investigators. Association of clinical, ımaging, and thrombus characteristics with recanalization of visible ıntracranial occlusion in patients with acute ıschemic stroke. JAMA 2018; 320(10): 1017-26.
7. Narcı H, Oktay MM, Ayrık C, Çimen MBY. Nucleated red blood cells as predictor of all-cause mortality in emergency department. Am J Emerg Med 2021; 46: 335-8.
8. Narcı H, Berkeşoğlu M, Üçbilek E, Ayrık C. The usefulness of the percentage of immature granulocytes in predicting inhospital mortality in patients with upper gastrointestinal bleeding. Am J Emerg Med 2021; 46: 646-50.
9. May JE, Marques MB, Reddy VVB, Gangaraju R. Three neglected numbers in the CBC: The RDW, MPV, and NRBC count. Cleve Clin J Med 2019; 86(3): 167-72.
10. Stachon A, Holland-Letz T, Kempf R, Becker A, Friese J, Krieg M. Poor prognosis indicated by nucleated red bloodcells in peripheral blood is not associated with organ failure ofthe liver or kidney. Clin Chem Lab Med 2006; 44(8): 955-61.
11. Menk M, Giebelhäuser L, Vorderwülbecke G, Gassner M, Graw JA, Weiss B et al. Nucleated red blood cells as predictors of mortality in patients with acute respiratory distress syndrome (ARDS): an observational study. Ann Intensive Care 2018; 8(1): 42.
12. Desai S, Jones SL, Turner KL, Hall J, Moore LJ. Nucleated red blood cells are associated with a higher mortality rate in patients with surgical sepsis. Surg Infect (Larchmt) 2012; 13(6): 360-5.
13. Xu C, Wang J, Jin X, Yuan Y, Lu G. Establishment of a predictive model for outcomes in patients with severe acute pancreatitis by nucleated red blood cells combined with Charlson complication index and APACHE II score. Turk J Gastroenterol 2020; 31(12): 936-41.
14. Macichová M, Grochová M, Rácz O, Firment J, Mitníková M, Rosenberger J et al. Improvement of mortality prediction accuracy in critically ill patients through combination of SOFA and APACHE II score with markers of stress haematopoiesis. Int J Lab Hematol 2020; 42(6): 796-800.
15. Stachon A, Becker A, Kempf R, Holland-Letz T, Friese J, Krieg M. Re-evaluation of established risk scores by measurement of nucleated red blood cells in blood of surgical intensive care patients. J Trauma 2008; 65(3): 666-73.
16. Monteiro Júnior JG, Torres Dde O, da Silva MC, Ramos TM, Alves ML, Nunes Filho WJ et al. Nucleated Red Blood Cells as Predictors of All-Cause Mortality in Cardiac Intensive Care Unit Patients: A Prospective Cohort Study. PLoS One 2015; 10(12): e0144259.
17. Ansari Lari MA, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol 2003; 120(5): 795-9.
18. Monteiro Júnior JGM, de Oliveira Cipriano Torres D, Filho DCS. Hematological parameters as prognostic biomarkers in patients with cardiovascular diseases. Curr Cardiol Rev 2019; 15(4): 274-82.
19. Bedel C, Korkut M, Avcı A, Uzun A. Immature granulocyte count and percentage as new predictors of mortality in patients with upper gastrointestinal bleeding. Indian J Crit Care Med 2020; 24(9): 794-8.
20. Ünal Y, Barlas AM. Role of increased immature granulocyte percentage in the early prediction of acute necrotizing pancreatitis. Role of increased immature granulocyte percentage in the early prediction of acute necrotizing pancreatitis. Ulus Travma Acil Cerrahi Derg 2019; 25(2): 177-82.
21. Park JS, Kim JS, Kim YJ, Kim WY. Utility of the immature granulocyte percentage for diagnosing acute appendicitis among clinically suspected appendicitis in adult. J Clin Lab Anal 2018; 32(7): e22458.
22. Ayres LS, Sgnaolin V, Munhoz TP. Immature granulocytes index as early marker of sepsis. Int J Lab Hematol 2019; 41(3) :392-6.
23. Morton SU, Brettin K, Feldman HA, Leeman KT. Association of nucleated red blood cell count with mortality among neonatal intensive care unit patients. Pediatr Neonatol 2020; 61(6): 592-7.
24. Poryo M, Wissing A, Zemlin M, Aygün A, Ebrahimi-Fakhari D, Geisel J et al. Nucleated red blood cells and serum lactate values on days 2 and 5 are associated with mortality and morbidity in VLBW infants. Normoblasten und Serum laktat konzentrationen an Lebenstag 2 und 5 sind mit Mobidität und Mortalität von VLBW-Neonaten assoziiert. Wien Med Wochenschr 2019; 169(3-4): 87-92.
25. Baschat AA, Gembruch U, Reiss I, Gortner L, Harman CR. Neonatal nucleated red blood cell count and postpartum complications in growth restricted fetuses. J Perinat Med 2003; 31(4) :323-9.
26. Stachon A, Segbers E, Holland-Letz T, Kempf R, Hering S, Krieg M. Nucleated red blood cells in the blood of medical intensive care patients indicate increased mortality risk: a prospective cohort study. Crit Care 2007; 11(3): R62.
27. Stachon A, Sondermann N, Imohl M, Krieg M. Nucleated red blood cells indicate high risk of in-hospital mortality. J Lab Clin Med 2002; 140(6) :407-12.
28. Sauneuf B, Bouffard C, Cornet E, Daubin C, Desmeulles I, Masson R et al. Immature/total granulocyte ratio: a promising tool to assess the severity and the outcome of post-cardiac arrest syndrome. Resuscitation 2014; 85(8): 1115-9.
29. Karakulak S, Narcı H, Ayrık C, Erdoğan S, Üçbilek E. The prognostic value of immature granulocyte in patients with acute pancreatitis. Am J Emerg Med 2021; 44: 203-7.