AUTHOR=Chen Qian , Liu Jinjin , Xu Haoli , He Wenwen , Li Yanxuan , Jiao Lizhuo , Xiang Yilan , Zhan Chenyi , Chen Jie , Yang Xiaoming , Huang Shengwei , Yang Yunjun 

TITLE=Association Between Eosinophilic Leukocyte Count and Hematoma Expansion in Acute Spontaneous Intracerebral Hemorrhage

JOURNAL=Frontiers in Neurology

VOLUME=Volume 10 - 2019

YEAR=2019

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.01164

DOI=10.3389/fneur.2019.01164

ISSN=1664-2295

ABSTRACT=Background/Objective: Hematoma expansion (HE) predicts poor outcome and is an appealing treatment target in spontaneous intracerebral hemorrhage (ICH). Clinical evidence has shown an association of HE with peripheral white blood cells (WBC) count, but the individual contributions of leukocyte types between literatures are described inconsistently. Our aim was to determine the relationship between admission absolute and differential leukocyte counts and HE by using various growth definitions.
Methods: We analyzed spontaneous ICH patients who underwent baseline cranial computed tomography and blood sampling within 6 hours of stroke onset in our institution between September 2013 and August 2018. Hematoma volume was calculated using a semiautomated 3-dimensional reconstruction algorithm. According to commonly used absolute or relative growth definitions (>6 mL, >12.5 mL, or >33%), we defined 5 types of HE. Univariate and multivariable logistic regression models were constructed to evaluated the influence of complete blood count components on HE. The receiver operating characteristic analysis assessed the predictive ability of leukocyte counts for HE.
Results: A total of 1066 patients were included, of whom 11% to 21% met the 5 HE definitions. Except using the absolute definition of >12.5 mL growth, both WBC and neutrophil count were independently associated with reduced risk of HE (odds ratio [OR] for 1000 cells increase; OR, 0.92-0.96; all p <0.05) after adjusting confounders in multivariate analyses. However, monocyte count was correlated with increased risk of HE only when this definition was used (OR, 1.98; p =0.009). There was no association between lymphocyte count and HE (all p > 0.05). Regardless of the growth definition, admission eosinophil count was directly associated with the risk of HE (OR, 3.64-6.71; all p <0.05), and was the best predictive subtype with the area under the curve 0.64, sensitivity 69.5%, and specificity 58.9% at the optimal cut-off value of 45 cells/uL.
Conclusions: Growth definition affects the relationship of HE with leukocyte subtypes counting. Eosinophil count robustly predict HE, and may be a surrogate when using an inflammatory marker to help select acute ICH patients with high expansion risk for hemostasis treatment in clinical trial and practice.