Relationship between blood parameters, type of treatment and mortality in hemorrhagic strokes

Objective: While hemorrhagic strokes constitute approximately 20% of all cerebrovascular diseases, early diagnosis and intervention are of great importance due to their high morbidity and mortality. Subarachnoid hemorrhages (SAH) and intraparenchymal hemorrhages (IPH) are distinct subtypes with differing pathogenic mechanisms. Our study aims to distinguish between SAH and IPH by examining current inflammatory markers such as neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR), along with the plasma atherogenic index (PAI). Furthermore, we seek to evaluate the predictive value of these parameters in determining the necessity for surgery and mortality. Materials and Methods: The study was conducted as a retrospective cohort at Kırşehir Ahi Evran University Faculty of Medicine Hospital with patients presenting with hemorrhagic stroke between 01/09/2019 and 01/09/2023. Inclusion criteria for the study were patients diagnosed with hemorrhagic stroke through imaging methods and aged 18 and above. In addition to the patient's clinical and demographic data, hematological parameters such as NLR, MLR, PLR, and lipid profiles were recorded for those whose lipid profiles were studied. The PAI value was calculated as the logarithmic transformation of the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-K) with a base of 10. Mortality rates at 48 hours, one month, and three months were examined for the patients. The need for surgical treatment was also assessed. The study's primary outcome was the relationship between mortality and NLR, MLR, PLR, and PAI. Secondary outcomes included determining the value of these parameters in identifying the need for surgery and assessing the distribution of these values between SAH and IPH. A statistical significance level of p< 0.05 was accepted. Results: The study involved a total of 176 patients with hemorrhagic stroke. Subarachnoid hemorrhage (SAH) was observed in 22 patients (12.5%), while intraparenchymal hemorrhage (IPH) was observed in 154 patients (87.5%). The most common comorbidity was hypertension, found in 48.3% of the patients. Thirty patients (17%) died within the first 48 hours, 70 patients (39.8%) within one month, and 75 patients (42.6%) within three months. No patients in the SAH group required surgical treatment, while 15 patients (9.7%) in the IPH group required surgery. HDL was significantly higher in the SAH group (p<0.001), while PAI (p=0.002), NLR (p=0.010), MLR (p=0.004), and PLR (p=0.008) values were significantly higher in the IPH group. However, there was no significant difference in these parameters between treatment and mortality groups (all p>0.05). Conclusion: Based on the findings of this study, it was discovered that the IPH group had older individuals, more frequent cases of hypertension, and a higher use of antihypertensive medication compared to the SAH group. Furthermore, the HDL-C levels were significantly lower in the IPH group compared to the SAH group. The rates of PAI, NLR, MLR, and PLR were higher in the IPH group as well. However, no significant difference was observed between surgical and conservative treatments for both IPH and SAH patients. Additionally, no significant difference was observed in terms of mortality outcome between the two groups. Since SAH and IPH have different causes, these parameters may be crucial in monitoring high-risk patients for IPH. Further studies with ongoing monitoring are still needed. Keywords: Hemorrhagic Stroke, Neutrophil -Lymphocyte Ratio, Monocyte -Lymphocyte Ratio, Platelet-Lymphocyte Ratio, Plasma Atherogenic Index, Emergency Medicine