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Inflammatory Biomarkers and Intracranial Hemorrhage after Endovascular Thrombectomy
Published online by Cambridge University Press: 20 August 2021
Abstract:
Background:
Intracranial hemorrhage after endovascular thrombectomy is associated with poorer prognosis compared with those who do not develop the complication. Our study aims to determine predictors of post-EVT hemorrhage – more specifically, inflammatory biomarkers present in baseline serology.
Methods:
We performed a retrospective review of consecutive patients treated with EVT for acute large vessel ischemic stroke. The primary outcome of the study is the presence of ICH on the post-EVT scan. We used four definitions: the SITS-MOST criteria, the NINDS criteria, asymptomatic hemorrhage, and overall hemorrhage. We identified nonredundant predictors of outcome using backward elimination based on Akaike Information Criteria. We then assessed prediction accuracy using area under the receiver operating curve. Then we implemented variable importance ranking from logistic regression models using the drop in Naegelkerke R2 with the exclusion of each predictor.
Results:
Our study demonstrates a 6.3% SITS (16/252) and 10.0% NINDS (25/252) sICH rate, as well as a 19.4% asymptomatic (49/252) and 29.4% (74/252) overall hemorrhage rate. Serologic markers that demonstrated association with post-EVT hemorrhage were: low lymphocyte count (SITS), high neutrophil count (NINDS, overall hemorrhage), low platelet to lymphocyte ratio (NINDS), and low total WBC (NINDS, asymptomatic hemorrhage).
Conclusion:
Higher neutrophil counts, low WBC counts, low lymphocyte counts, and low platelet to lymphoycyte ratio were baseline serology biomarkers that were associated with post-EVT hemorrhage. Our findings, particularly the association of diabetes mellitus and high neutrophil, support experimental data on the role of thromboinflammation in hemorrhagic transformation of large vessel occlusions.
Résumé :
Biomarqueurs inflammatoires et hémorragie intracrânienne à la suite d’une thrombectomie endovasculaire.
Le fait d’être victime d’une hémorragie intracrânienne (HIC) à la suite d’une thrombectomie endovasculaire (TEV) est associé à un pronostic plus défavorable par rapport à des patients qui ne développent pas cette complication. Notre étude vise ainsi à déterminer les prédicteurs d’une hémorragie post-TEV, plus particulièrement les biomarqueurs inflammatoires présents dans la sérologie de base.
Nous avons réalisé une étude rétrospective de patients vus consécutivement qui ont été traités au moyen d’une TEV dans le cas d’AVC ischémiques aigus affectant de larges vaisseaux sanguins. Le principal aspect mesuré dans cette étude a été la présence d’une HIC détectée à l’occasion d’un examen de tomodensitométrie post-TEV. Nous avons aussi fait appel à quatre définitions : SITS-MOST (safe implementation of thrombolysis in stroke-monitoring study), NINDS (National Institute of Neurological Disorders and Stroke), hémorragie asymptomatique et hémorragie globale. De plus, nous avons identifié des prédicteurs non-redondants en utilisant une rétro-élimination basée sur le critère d’information d’Akaike. Nous avons ensuite évalué la précision de ces prédicteurs en utilisant la fonction d’efficacité du récepteur. Finalement, nous avons mis en œuvre le classement par importance des variables à partir de modèles de régression logistique en utilisant la diminution du R2 de Naegelkerke avec l’exclusion de chaque prédicteur.
En fonction des définitions SITS-MOST et NINDS, notre étude a montré respectivement un taux d’HIC de 6,3 % (16/252) et de 10,0 % (25/252). Les taux d’hémorragie asymptomatique et d’hémorragie globale ont été respectivement de 19,4 % (49/252) et de 29,4 % (74/252). Les marqueurs sérologiques qui ont montré une association avec des cas d’hémorragie post-EVT ont été les suivants : faible nombre de lymphocytes (SITS), nombre élevé de neutrophiles (NINDS, hémorragie globale), faible rapport plaquettes/lymphocytes (NINDS) et faible total de globules blancs (NINDS, hémorragie asymptomatique).
Un nombre élevé de neutrophiles, un faible total de globules blancs, un faible nombre de lymphocytes ainsi qu’un faible rapport plaquettes/lymphocytes sont les biomarqueurs sérologiques de base qui ont été associés à des cas d’hémorragie post-TEV. Nos résultats, en particulier l’association entre le diabète sucré et un taux élevé de neutrophiles, confirment les données expérimentales quant au rôle de la thrombo-inflammation dans les transformations hémorragiques consécutives à l’occlusions de larges vaisseaux sanguins.
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- © The Author(s), 2021. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
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