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The relationship between hematological parameters and prognosis of children with acute ischemic stroke

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Abstract

Background

Stroke is rarely seen in children, but it is a major cause of morbidity and mortality. Therefore, there is a need for inexpensive and noninvasive diagnostic methods for estimating the prognosis. Although the prognostic importance of hematological parameters in acute ischemic stroke were reported in adult studies, there is a lack in pediatric ages. The aim of the study is to investigate the relationship between hematological parameters and prognosis of acute ischemic stroke in children.

Methods

Retrospectively scanned in the study were 106 pediatric patients with acute ischemic stroke who managed at the Medical Faculty of Erciyes University, Kayseri, between the years of 2000 and 2014. White blood count (WBC); neutrophil, lymphocyte, and platelet count; mean platelet volume (MPV); platelet distribution width (PDW); neutrophil count/lymphocyte count (N/L) ratio values obtained from the measurements and initial symptoms; demographical features; risk factors; neurological examination; and clinical follow-up were recorded. Their hematological parameters were compared with those of 106 age and sex-matched healthy individuals.

Results

MPV and PDW values were found similar in patient and control groups, and the platelet count was found significantly low in the control group (p = 0,028). WBC, neutrophil count, and N/L ratio were found considerably high in the patient group (p < 0.001). Lymphocyte count, however, was found significantly low in the control group (p < 0.001). No statistically significant difference was detected in WBC, neutrophil count, lymphocyte count, platelet count, N/L ratio, and MPV and PDW values between the group with sequelae and the one without sequelae. In addition, it was determined that WBC, neutrophil count, lymphocyte count, platelet count, N/L ratio, and MPV and PDW values in the univariate Cox-regression analysis of the patient group had no effect on survival and disease-free survival. When receiver operating characteristic curve was applied, it was observed that the area below WBC, N/L ratio curve was important in the patient group in terms of predicting acute ischemic stroke.

Conclusion

The values of WBC, neutrophil count, and N/L ratio differ significantly from those of the control group. The WBC and N/L ratio may help for an earlier diagnosis in children with acute ischemic stroke. WBC, thrombocyte count, MPV, PDW, and N/L ratio do not constitute a risk in overall survival, disease-free survival, and sequelae development.

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References

  1. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T (1980) Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ 58(1):113–130

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Ganesan V, Hogan A, Shack N, Gordon A, Isaacs E, Kirkham FJ (2000) Outcome after ischaemic stroke in childhood. Dev Med Child Neurol 42(7):455–461. https://doi.org/10.1017/S0012162200000852

    Article  CAS  PubMed  Google Scholar 

  3. Giroud M, Lemesle M, Gouyon JB, Nivelon JL, Milan C, Dumas R (1995) Cerebrovascular disease in children under 16 years of age in the city of Dijon, France: a study of incidence and clinical features from 1985 to 1993. J Clin Epidemiol 48(11):1343–1348. https://doi.org/10.1016/0895-4356(95)00039-9

    Article  CAS  PubMed  Google Scholar 

  4. Lanska MJ, Lanska DJ, Horwitz SJ, Aram DM (1991) Presentation, clinical course, and outcome of childhood stroke. Pediatr Neurol 7(5):333–341. https://doi.org/10.1016/0887-8994(91)90062-P

    Article  CAS  PubMed  Google Scholar 

  5. Ganesan V, Prengler M, McShane MA, Wade AM, Kirkham FJ (2003) Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol 53:167–173

    Article  PubMed  Google Scholar 

  6. Miravet E, Danchaivijitr N, Basu H, Saunders DE, Ganesan V (2007) Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol 49(6):417–422. https://doi.org/10.1111/j.1469-8749.2007.00417.x

    Article  PubMed  Google Scholar 

  7. Per H, Unal E, Poyrazoglu HG, Ozdemir MA, Donmez H, Gumus H, Uzum K, Canpolat M, Akyildiz BN, Coskun A, Kurtsoy A, Kumandas S (2014) Childhood stroke: results of 130 children from a reference center in central Anatolia, Turkey. Pediatr Neurol 50(6):595–600. https://doi.org/10.1016/j.pediatrneurol.2013.12.023

    Article  PubMed  Google Scholar 

  8. Jordan LC, Hillis AE (2011) Challenges in the diagnosis and treatment of pediatric stroke. Nat Rev Neurol 7(4):199–208. https://doi.org/10.1038/nrneurol.2011.23

    Article  PubMed  PubMed Central  Google Scholar 

  9. Goksuluk D, Korkmaz S, Zararsiz G, Karaagaoglu E (2016) easyROC: an interactive web-tool for ROC curve analysis using R language environment. R J 8:213–230

    Google Scholar 

  10. Korkmaz S, Goksuluk D, Zararsiz G (2014) MVN: an R package for assessing multivariate normality. R J 6:151–162

    Google Scholar 

  11. Wang PY, Kao CH, Mui MY, Wang SJ (1993) Leukocyte infiltration in acute hemispheric ischemic stroke. Stroke 24(2):236–240. https://doi.org/10.1161/01.STR.24.2.236

    Article  CAS  PubMed  Google Scholar 

  12. Fassbender K, Rossol S, Kammer T, Daffertshofer M, Wirth S, Dollman M, Hennerici M (1994) Proinflammatory cytokines in serum of patients with acute cerebral ischemia: kinetics of secretion and relation to the extent of brain damage and outcome of disease. J Neurol Sci 122(2):135–139. https://doi.org/10.1016/0022-510X(94)90289-5

    Article  CAS  PubMed  Google Scholar 

  13. Akopov SE, Simonian NA, Grigorian GS (1996) Dynamics of polymorphonuclear leukocyte accumulation in acute cerebral infarction and their correlation with brain tissue damage. Stroke 27(10):1739–1743. https://doi.org/10.1161/01.STR.27.10.1739

    Article  CAS  PubMed  Google Scholar 

  14. Mori E, del Zoppo GJ, Chambers JD, Copeland BR, Arfors KE (1992) Inhibition of polymorphonuclear leukocyte adherence suppresses no-reflow after focal cerebral ischemia in baboons. Stroke 23(5):712–718. https://doi.org/10.1161/01.STR.23.5.712

    Article  CAS  PubMed  Google Scholar 

  15. Buck BH, Liebeskind DS, Saver JL, Bang OY, Yun SW, Starkman S, Ali LK, Kim D, Villablanca JP, Salamon N, Razinia T, Ovbiagele B (2008) Early neutrophilia is associated with volume of ischemic tissue in acute stroke. Stroke 39(2):355–360. https://doi.org/10.1161/STROKEAHA.107.490128

    Article  PubMed  Google Scholar 

  16. Elkind MS, Sciacca RR, Boden-Albala B, Rundek T, Paik MC, Sacco RL (2005) Relative elevation in baseline leukocyte count predicts first cerebral infarction. Neurology 64(12):2121–2125. https://doi.org/10.1212/01.WNL.0000165989.12122.49

    Article  CAS  PubMed  Google Scholar 

  17. Celikbilek A, Ismailogullari S, Zararsiz G (2014) Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal 28(1):27–31. https://doi.org/10.1002/jcla.21639

    Article  CAS  PubMed  Google Scholar 

  18. Guldiken B, Ozkan H, Kabayel L (2008) Mean platelet volume and peripheral blood count response in acute ischemic stroke. Trakya Univ Tıp Fak Derg 25:130–135

    Google Scholar 

  19. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91(3):181–184. https://doi.org/10.1002/jso.20329

    Article  CAS  PubMed  Google Scholar 

  20. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS (2008) Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 102(6):653–657. https://doi.org/10.1016/j.amjcard.2008.05.006

    Article  PubMed  Google Scholar 

  21. Tschoepe D, Roesen P, Esser J, Schwippert B, Nieuwenhuis HK, Kehrel B, Gries FA (1991) Large platelets circulate in an activated state in diabetes mellitus. Semin Thromb Hemost 17(04):433–438. https://doi.org/10.1055/s-2007-1002650

    Article  CAS  PubMed  Google Scholar 

  22. Debili N, Massé JM, Katz A, Guichard J, Breton-Gorius J, Vainchenker W (1993) Effects of the recombinant hematopoietic growth factors interleukin-3, interleukin-6, stem cell factor, and leukemia inhibitory factor on the megakaryocytic differentiation of CD34+ cells. Blood 82(1):84–95

    CAS  PubMed  Google Scholar 

  23. Jakubowski JA, Thompson CB, Vaillancourt R, Valeri CR, Deykin D (1983) Arachidonic acid metabolism by platelets of differing size. Br J Haematol 53(3):503–511. https://doi.org/10.1111/j.1365-2141.1983.tb02052.x

    Article  CAS  PubMed  Google Scholar 

  24. Haver VM, Gear AR (1981) Functional fractionation of platelets. J Lab Clin Med 97(2):187–204

    CAS  PubMed  Google Scholar 

  25. Bath PM, Butterworth RJ (1996) Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 7(2):157–161. https://doi.org/10.1097/00001721-199603000-00011

    Article  CAS  PubMed  Google Scholar 

  26. Sharp DS, Benowitz NL, Bath PM, Martin JF, Beswick AD, Elwood PC (1995) Cigarette smoking sensitizes and desensitizes impedance-measured ADP-induced platelet aggregation in whole blood. Thromb Haemost 74(2):730–735

    CAS  PubMed  Google Scholar 

  27. Bath P, Algert C, Chapman N, Neal B, PROGRESS Collaborative Group (2004) Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke 35:622–666

    Article  PubMed  Google Scholar 

  28. Du J, Wang Q, He B, Liu P, Chen JY, Quan H, Ma X (2016) Association of mean platelet volume and platelet count with the development and prognosis of ischemic and hemorrhagic stroke. Int J Lab Hematol 38(3):233–239. https://doi.org/10.1111/ijlh.12474

    Article  CAS  PubMed  Google Scholar 

  29. Celik T, Unal S, Ekinci O, Ozer C, Ilhan G, Oktay G, Arica V (2015) Mean platelet volume can predict cerebrovascular events in patients with sickle cell anemia. Pak J Med Sci 31(1):203–208. 10.12669/pjms.311.4104

    PubMed  PubMed Central  Google Scholar 

  30. Muscari A, Puddu GM, Cenni A, Silvestri MG, Giuzio R, Rosati M, Santoro N, Bianchi G, Magalotti D, Zoli M (2009) Mean platelet volume (MPV) increase during acute non-lacunar ischemic strokes. Thromb Res 123(4):587–591. https://doi.org/10.1016/j.thromres.2008.03.025

    Article  CAS  PubMed  Google Scholar 

  31. Ntaios G, Gurer O, Faouzi M, Aubert C, Michel P (2010) Mean platelet volume in the early phase of acute ischemic stroke is not associated with severity or functional outcome. Cerebrovasc Dis 29(5):484–489. https://doi.org/10.1159/000297964

    Article  PubMed  Google Scholar 

  32. Farah R, Samra N (2017) Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke. J Clin Lab Anal. https://doi.org/10.1002/jcla.22189)

  33. Jindal S, Gupta S, Gupta R, Kakkar A, Singh HV, Gupta K, Singh S (2011) Platelet indices in diabetes mellitus: indicators of diabetic micro-vascular complications. Hematology 16(2):86–89. https://doi.org/10.1179/102453311X12902908412110

    Article  PubMed  Google Scholar 

  34. Adam G, Kocak E, Ozkan A, Resorlu M, Cinar C, Bozkaya H, Kurt T, Altun B, Sen HM, Akbal A, Bozkurt N, Sacar M (2015) Evaluation of platelet distribution width and mean platelet volume in patients with carotid artery stenosis. Angiology 66(4):375–378. https://doi.org/10.1177/0003319714548682

    Article  PubMed  Google Scholar 

  35. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I (2010) Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 14(1):28–32

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Chen Y, Xiao Y, Lin Z, Xiao X, He C, Bihl JC, Zhao B, Ma X, Chen Y (2015) The role of circulating platelets microparticles and platelet parameters in acute ischemic stroke patients. J Stroke Cerebrovasc Dis 24(10):2313–2320. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.018

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, Erciyes University, 38039, Talas, Kayseri, Turkey

    Ebru Yilmaz, Adil Bozpolat, Musa Karakukcu, Turkan Patiroglu, Mehmet Akif Ozdemir, Alper Ozcan & Ekrem Unal

  2. Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Kayseri, Turkey

    Ayse Bayram Kacar, Hakan Gumus & Huseyin Per

  3. Faculty of Medicine, Department of Biostatistics and Medical Informatics, Erciyes University, Kayseri, Turkey

    Gokmen Zararsiz

  4. Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Erciyes University, Kayseri, Turkey

    Burcu S. Gorkem

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  1. Ebru Yilmaz
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Correspondence to Ekrem Unal.

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Yilmaz, E., Bayram Kacar, A., Bozpolat, A. et al. The relationship between hematological parameters and prognosis of children with acute ischemic stroke. Childs Nerv Syst 34, 655–661 (2018). https://doi.org/10.1007/s00381-017-3673-x

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  • DOI: https://doi.org/10.1007/s00381-017-3673-x

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