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Peer-reviewedCC BY 4.0Frontiers in Neurology

Co-occurring leukocytosis and hyperglycemia identify patients at high risk of subsequent mortality after intracerebral hemorrhage: a 24-h landmark analysis in MIMIC-IV and eICU

  • Hanrong Liang1
  • Wenjuan Jing2
  • Laixin Song3
  • Diqun Wu3
  • Shenhui Xiao3
  • Haoxin Liu4
  • Yuan Zhong3
4 affiliations
  1. 1Interventional Operating Room, School of Medicine, The Sixth Affiliated Hospital of South China University of Technology (Nanhai District People's Hospital of Foshan)
  2. 2Foshan Sanshui District People's Hospital
  3. 3Department of Cerebrovascular Intervention, School of Medicine, The Sixth Affiliated Hospital of South China University of Technology (Nanhai District People's Hospital of Foshan)
  4. 4Department of Neurosurgery, Zhongnan Hospital of Wuhan University
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Abstract

Background: White blood cell (WBC) count and glucose levels may jointly reflect physiological stress after intracerebral hemorrhage (ICH). We examined their associations with subsequent in-hospital mortality and whether they improved prediction beyond established clinical information.

Methods: This retrospective study used the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database. Adults with ICH identified by diagnosis codes who were alive and hospitalized 24 h after intensive care unit admission were included. WBC > 10 × 10 ⁹ /L and glucose >140 mg/dL defined four groups: neither elevated, WBC elevation only, glucose elevation only, and both elevated. Logistic regression estimated adjusted associations, with bias reduction in the eICU cohort. Restricted cubic splines assessed nonlinear associations. Prediction models used the minimum first-day Glasgow Coma Scale score alone or a clinical baseline model that also included age, sex, blood pressure, and other laboratory measurements. Models were developed on MIMIC-IV and evaluated without updating in the eICU database.

Results: The MIMIC-IV and eICU landmark cohorts included 1,606 and 264 patients, with 332 and 42 subsequent deaths, respectively. Adjusted odds ratios for both markers elevated versus neither elevated were 2.98 (95% confidence interval [CI], 2.04–4.36) in MIMIC-IV and 3.34 (95% CI, 0.97–11.54) in eICU. The glucose association in MIMIC-IV was nonlinear ( p = 0.005), whereas the WBC curve varied with the spline specification. Among 229 eICU patients with both markers measured, adding the joint category to the clinical baseline model changed the area under the receiver operating characteristic curve from 0.796 to 0.811 (difference, 0.014; 95% CI, −0.012 to 0.039) and the Brier score, a measure of prediction error, by −0.0017 (95% CI, −0.0075 to 0.0041).

Conclusion: Joint WBC–glucose elevation was associated with subsequent in-hospital mortality in MIMIC-IV, but estimates in the eICU cohort were imprecise. Additional predictive value remained uncertain, and continuous analyses did not establish a stable U-shaped association.

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Cite

BibTeXRIS
BibTeX
@article{liang2026cooccurring,
  title = {{Co-occurring leukocytosis and hyperglycemia identify patients at high risk of subsequent mortality after intracerebral hemorrhage: a 24-h landmark analysis in MIMIC-IV and eICU}},
  author = {Hanrong Liang and Wenjuan Jing and Laixin Song and Diqun Wu and Shenhui Xiao and Haoxin Liu and Yuan Zhong},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1956229},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1956229/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Co-occurring leukocytosis and hyperglycemia identify patients at high risk of subsequent mortality after intracerebral hemorrhage: a 24-h landmark analysis in MIMIC-IV and eICU
AU  - Hanrong Liang
AU  - Wenjuan Jing
AU  - Laixin Song
AU  - Diqun Wu
AU  - Shenhui Xiao
AU  - Haoxin Liu
AU  - Yuan Zhong
PY  - 2026
DA  - 2026/10/30
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1956229
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1956229/full
AB  - Background: White blood cell (WBC) count and glucose levels may jointly reflect physiological stress after intracerebral hemorrhage (ICH). We examined their associations with subsequent in-hospital mortality and whether they improved prediction beyond established clinical information.  Methods: This retrospective study used the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database. Adults with ICH identified by diagnosis codes who were alive and hospitalized 24 h after intensive care unit admission were included. WBC > 10 × 10 ⁹ /L and glucose >140 mg/dL defined four groups: neither elevated, WBC elevation only, glucose elevation only, and both elevated. Logistic regression estimated adjusted associations, with bias reduction in the eICU cohort. Restricted cubic splines assessed nonlinear associations. Prediction models used the minimum first-day Glasgow Coma Scale score alone or a clinical baseline model that also included age, sex, blood pressure, and other laboratory measurements. Models were developed on MIMIC-IV and evaluated without updating in the eICU database.  Results: The MIMIC-IV and eICU landmark cohorts included 1,606 and 264 patients, with 332 and 42 subsequent deaths, respectively. Adjusted odds ratios for both markers elevated versus neither elevated were 2.98 (95% confidence interval [CI], 2.04–4.36) in MIMIC-IV and 3.34 (95% CI, 0.97–11.54) in eICU. The glucose association in MIMIC-IV was nonlinear ( p = 0.005), whereas the WBC curve varied with the spline specification. Among 229 eICU patients with both markers measured, adding the joint category to the clinical baseline model changed the area under the receiver operating characteristic curve from 0.796 to 0.811 (difference, 0.014; 95% CI, −0.012 to 0.039) and the Brier score, a measure of prediction error, by −0.0017 (95% CI, −0.0075 to 0.0041).  Conclusion: Joint WBC–glucose elevation was associated with subsequent in-hospital mortality in MIMIC-IV, but estimates in the eICU cohort were imprecise. Additional predictive value remained uncertain, and continuous analyses did not establish a stable U-shaped association.
SN  - 1664-2295
ER  -