MONOCYTES AND LYMPHOCYTES PROGNOSIS TOOLS AMONG STROKE PATIENTS
DOI:
https://doi.org/10.22159/ijms.2021.v9i4.39592Keywords:
Lymphocyte-to-monocyte ratio, Acute ischemic stroke, Stroke severity, Prognosis, Neutrophil to monocyteAbstract
Objectives: The values of white blood cell types were evaluated to determine which one is the most potential index in the diagnosis of patients with ischemic stroke (IS). Besides, neutrophil-lymphocyte ratio, neutrophil-to-monocyte ratio, and lymphocyte-to-monocyte ratio (LMR) were determined to confirm whether there is a relationship between these parameters and stroke.
Methods: One thousand files of patients admitted between January 2017 and March 2020 to intensive care units at Alia Governmental Hospital in Hebron-Palestine were reviewed and evaluated. Only a total of 87 patients were found to meet our inclusion criteria and included in the study and a total of 913 patients were excluded. Besides, complete blood counts of a total of 95 patients’ data were also collected randomly from Private Lab in Hebron district, and were considered as healthy individuals (HI); that is, a control group. The data were introduced to the excel program 2010 version to facilitate reading and analysis. GraphPad Prism version (8.3.4.) was used to analyze the data. The data of patients and HI were compared to determine which value/s of these blood components is associated with the risk of stroke.
Results: Different types of white blood cells; monocytes, lymphocytes, and neutrophils for stroke and healthy patients were collected and compared. Besides, the platelet count was also compared. It was found a marked significant decrease in the monocytes counts in all stroke patients (100–1500 cell/ul) compare to monocytes counts in the healthy donors (310–1740 cell/ul). Lymphocytes were also significantly decreased among all stroke patients (300–8600 cells/ul) compare to HI (910–9000 cells/ul). There was no significant increase in neutrophils in stroke patients. The ratios of neutrophils to monocytes and neutrophils to lymphocytes in stroke patients were compared too. The results showed a significantly elevated neutrophil ratio compare to monocytes and lymphocytes in all stroke patients. The platelet counts in stroke patients were also found less compared to HI. The percentages of these blood components were also evaluated.
Conclusion: It is demonstrated that patients with stroke have lower lymphocyte and higher monocyte counts, and therefore, lower LMR values compared to the control group. It was found that MLR was significantly correlated with IS. LMR is associated with functional outcomes in patients with stroke.
References
Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, et al. Heart disease and stroke statistics update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation 2007;115:e69-171.
Bolayir A, Gokce SF, Cigdem B, Bolayir HA, Yildiz OK, Bolayir E, et al. Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol 2018;52:150-5.
Rodrigues SF, Granger DN. Leukocyte-mediated tissue injury in ischemic stroke. Curr Med Chem 2014;21:2130-7.
Blake GJ, Ridker PM. Inflammatory bio-markers and cardiovascular risk prediction. JIM 2002;252:283-94.
Fassbender K, Bertsch T, Mielke O, Mühlhauser F, Hennerici M. Adhesion molecules in cerebrovascular diseases: Evidence for an inflammatory endothelial activation in cerebral large- and small-vessel disease. Stroke 1999;30:1647-50.
Sánchez-Moreno C, Dashe JF, Scott T, Thaler D, Folstein MF, Martin A. Decreased levels of plasma Vitamin C and increased concentrations of inflammatory and oxidative stress markers after stroke. Stroke 2004;35:163-8.
Arakelyan A, Petrkova J, Hermanova Z, Boyajyan A, Lukl J, Petrek M. Serum levels of the MCP-1 chemokine in patients with ischemic stroke and myocardial infarction. Mediat Inflamm 2005;2005:175-9.
Kim J, Song TJ, Park JH, Lee HS, Nam CM, Nam HS, et al. Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis 2012;222:464-7.
Pagram H, Bivard A, Lincz LF, Levi C. Peripheral immune cell counts and advanced imaging as biomarkers of stroke outcome. Cerebrovasc Dis Extra 2016;6:120-8.
Prentice RL, Szatrowski TP, Kato H, Mason MW. Leukocyte counts and cerebrovascular disease. J Chronic Dis 1982;35:703-14.
Fava M, Lamon-Fava. Leukocytes and the risk of ischemic diseases. JAMA 1987;258:907-8.
Gillum RF, Ingram DD, Makuc DM. White blood cell count and stroke incidence and death. The NHANES I epidemiologic follow-up study. Am J Epidemiol 1994;139:894–902.
Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke 2004;35:1147-52.
Blann AD, Tse W, Maxwell SJ, Waite MA. Increased levels of the soluble adhesion molecule E-selectin in essential hypertension. J Hypertens 1994;12:925-8.
DeSouza CA, Dengel DR, Macko RF, Cox K, Seals DR. Elevated levels of circulating cell adhesion molecules in uncomplicated essential hypertension. Am J Hypertens 1997;10:1335-41.
Madej A, Okopień B, Kowalski J, Haberka M, Herman ZS. Plasma concentrations of adhesion molecules and chemokines in patients with essential hypertension. Pharmacol Rep 2005;57:878-81.
Liberale L, Montecucco F, Bonaventura A, Casetta I, Seraceni S, Trentini A, et al. Monocyte count at onset predicts poststroke outcomes during a 90-day follow-up. Eur J Clin Invest 2017;47:702-10.
Zhu JY, Liu CC, Wang L, Zhong M, Tang HL, Wang H. Peripheral blood lymphocyte-to-monocyte ratio as a prognostic factor in advanced epithelial ovarian cancer: A multicenter retrospective study. J Cancer 2017;8:737-43.
Song W, Tian C, Wang K, Zhang RJ, Zou SB. The pretreatment lymphocyte to monocyte ratio predicts clinical outcome for patients with hepatocellular carcinoma: A meta-analysis. Sci Rep 2017;7:46601.
Ji H, Li Y, Fan Z, Zuo B, Jian X, Li L, Liu T. Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: A syntax score assessment. BMC Cardiovasc Disord 2017;17:90-5.
Ren H, Liu X, Wang L, Gao Y. Lymphocyte-to-monocyte ratio: A novel predictor of the prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis 2017;26:2595-602.
Bolayir A, Cigdem B, Gokce SF, Bolayir HA, Yildiz OK, Bolayir E, et al. The effect of eosinopenia on mortality in patients with intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2017;26:2248-55.
Xue J, Huang W, Chen X, Li Q, Cai Z, Yu T, et al. Neutrophil-to-lymphocyte ratio is a prognostic marker in acute ischemic stroke. J Stroke Cerebrovasc Dis 2017;26:650-7.
Tokgoz S, Kayrak M, Akpinar Z, Seyithanoğlu A, Güney F, Yürüten B. Neutrophil lymphocyte ratio as a predictor of stroke. J Stroke Cerebrovasc Dis 2013;22:1169-74.
Tokgoz S, Keskin S, Kayrak M, Seyithanoglu A, Ogmegul A. Is neutrophil/lymphocyte ratio predict to short-term mortality in acute cerebral infarct independently from infarct volume? J Stroke Cerebrovasc Dis 2014;23:2163-8.
Wang F, Hu S, Ding Y, Ju X, Wang L, Lu Q, et al. Neutrophil-to-lymphocyte ratio and 30-day mortality in patients with acute intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2016;25:182-7
Huber R, Abedalkhader RA, Küper D, Hauke L, Lüns B, Brand K, et al. Cellular and molecular effects of high-molecular-weight heparin on matrix metalloproteinase 9 expression. Int J Mol Sci 2019;20:1595.
Chriki LS, Bullain SS, Stern TA. The recognition and management of psychological reactions to stroke: A case discussion. Prim Care Companion J Clin Psychiatry 2006;8:234-40.
Balami JS, Chen RL, Grunwald IQ, Buchan AM. Neurological complications of acute ischaemic stroke. Lancet Neurol 2011;10:357-71.
Woodruff TM, Thundyil J, Tang SC, Sobey CG, Taylor SM, Arumugam TV. Pathophysiology, treatment, and animal and cellular models of human ischemic stroke. Mol Neurodegener 2011;6:11.
Malone K, Amu S, Moore AC, Waeber C. The immune system and stroke: From current targets to future therapy. Immunol Cell Biol 2019;97:5-16.
Akhtar N, Kamran S, Elkhider H, Al-Makki S, Mhjob N, ElShiekh L, et al. Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome. PLoS One 2020;15:e0231448.
El Ali A, LeBlanc NJ. The role of monocytes in ischemic stroke pathobiology: New avenues to explore. Front Aging Neurosci 2016;8:29.
Urra X, Cervera A, Obach V, Climent N, Planas AM, Chamorro A. Monocytes are major players in the prognosis and risk of infection after acute stroke. Stroke 2009;40:1262-8.
Nagler M, Keller P, Siegrist D, Alberio L. A case of EDTA-dependent pseudothrombocytopenia: Simple recognition of an underdiagnosed and misleading phenomenon. BMC Clin Pathol 2014;14:19.
Rababah M, Worthmann H, Deb M, Tryc AB, Ma YT, El Bendary OM, et al. Anticoagulants affect matrix metalloproteinase 9 levels in blood samples of stroke patients and healthy controls. Clin Biochem 2012;45:483-9.
Vogelgesang A, Grunwald U, Langner S, Jack R, Bröker BM, Kessler C, et al. Analysis of lymphocyte subsets in patients with stroke and their influence on infection after stroke. Stroke 2008;39:237-41.
Ren H, Han L, Liu H, Wang L, Liu X, Gao Y. Decreased lymphocyte-to-monocyte ratio predicts poor prognosis of acute ischemic stroke treated with thrombolysis. Med Sci Monit 2017;23:5826-33.
Rosales C, Lowell CA, Schnoor M, Uribe-Querol E. Neutrophils: Their role in innate and adaptive immunity. J Immunol Res 2017;2017:9748345.
Zuo B, Zhu S, Meng X, Zhao D, Zhang J. Monocyte/lymphocyte ratio is associated with carotid stenosis in ischemic stroke: A retrospective analysis. Brain Behav 2019;9:e01429.
Świtońska M, Słomka A, Korbal P, Piekuś-Słomka N, Sinkiewicz W, Sokal P, et al. Association of neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio with treatment modalities of acute ischaemic stroke: A pilot study. Medicina (Kaunas, Lithuania) 2019;55:342.
Lux D, Alakbarzade V, Bridge L, Clark CN, Clarke B, Zhang L, et al. The association of neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio with 3-month clinical outcome after mechanical thrombectomy following stroke. J Neuroinflamm 2020;17:60.
Published
How to Cite
Issue
Section
Copyright (c) 2021 Rozan Attili, Hatem A Hejaz, Ghaleb Bouti, Zahra Abu Fara, Hadeel Allan, Marwa Tamimi
This work is licensed under a Creative Commons Attribution 4.0 International License.