Study On The Relationship Between White Blood Cell Count And Hematoma Enlargement And Prognosis In Spontaneous Intracerebral Hemorrhage

Objective: The purpose of this study was to investigate the correlation between leukocytes and their subtypes neutrophils,lymphocytes,and monocytes in peripheral blood and early hematoma expansion and 90-day poor prognosis in patients with intracerebral hemorrhage(ICH).Methods: According to the inclusion and exclusion criteria,326 patients who were hospitalized in the Neurology Department of Baotou Central Hospital and diagnosed with intracerebral hemorrhage by head CT from June 2020 to August 2022 were collected.Collect general information(gender,age,past history,personal history,medication history,etc.),clinical data(blood routine examination,Glasgow Coma Scale,National Institute of Health stroke scale etc.).The 3D-slicer hematoma measurement software was used to measure the two hematoma volume values of the patients and culate the difference between the two hematoma volumes.According to the definition criteria of hematoma expansion,the enrolled patients were divided into hematoma expansion group and hematoma non-expansion group.Univariate and multivariate analysis were used to compare the baseline data of the two groups of patients to evaluate whether white blood cells,neutrophils,lymphocytes,monocytes and other baseline data were related to hematoma expansion.And then patients were followed up face-to-face or by telephone at 90 ± 7 days.The prognosis of the patients was evaluated with the modified Rankin scale,and the patients were divided into two groups according to the evaluation results.The m RS ≤ 2 points was defined as the good prognosis group,and the m RS > 2 points was defined as the poor prognosis group.Using univariate and multivariate analysis to compare the baseline data of the two groups of patients to evaluate whether the white blood cells,neutrophils,lymphocytes,monocytes and other baseline data are related to the poor prognosis of patients.The receiver operating characteristic was used to evaluate the predictive efficacy of each risk factor in the hematoma expansion group and the poor prognosis group.Results:(1)The initial hematoma volume(P=0.035)and admission NIHSS(p=0.021)of the hematoma expansion group were higher than those of the hematoma non-expansion group,and the admission GCS(p=0.005)was lower than that of the hematoma non-expansion group;The number of monocyte cells(p=0.007)was higher than that of the non-expanded hematoma group,and the ratio of neutrophils to monocytes(p=0.014)was lower than that of the non-expanded hematoma group.Multivariate logistic regression found that GCS score(OR=0.881,95%CI0.804-0.966,p=0.007)and monocytes(OR=1.442,95%CI 1.070-1.943,P=0.016)were risk factors for hematoma expansion.ROC analysis showed that GCS score(AUC=0.598,p=0.009)and monocytes(AUC=0.602,p=0.007)(2).The initial hematoma volume(p=0.007)and admission NIHSS(p<0.001)of the poor prognosis group were higher than those of the good prognosis group,and the admission GCS(p=0.001)was lower than that of the good prognosis group.In the poor prognosis group,white blood cells(p<0.001),neutrophils(p<0.001),monocytes(p<0.001),the ratio of neutrophils to monocytes(p=0.027),the ratio of neutrophils and lymphocytes(p < 0.001)was higher than that of the good prognosis group,and lymphocytes(p=0.045)、the ratio of lymphocytes to monocytes(p<0.001)was lower than that of the good prognosis group.Multivariate logistic regression found that hematoma expansion(OR=3.913,95%CI 2.073-7.387,P<0.001),white blood cells(OR=1.131,95%CI1.027-1.246,P=0.013),neutrophils(OR= 1.092,95%CI 1.009-1.182,P=0.028),monocytes(OR=2.480,95%CI 1.101-5.588,P=0.028),lymphocytes(OR=0.549,95%CI 0.322-0.937,P=0.028)is a risk factor for poor prognosis.ROC analysis showed hematoma expansion(AUC=0.619,p<0.001),white blood cells(AUC=0.627,p<0.001),monocytes(AUC=0.620,p<0.001),neutrophils(AUC=0.654,p<0.001)had good predictive value for poor prognosis,and lymphocytes had no significant predictive value for poor prognosis.Conclusion: ○1High monocyte count is associated with hematoma expansion in patients with intracerebral hemorrhage.○2 High white blood cells,high neutrophils,and high monocytes are associated with poor prognosis in patients with intracerebral hemorrhage.