Elevated Neutrophil-Lymphocyte Ratio is Predictive of Poor Outcomes Following Aneurysmal Subarachnoid Hemorrhage

Jamali, Sheheryar A.; Turnbull, Marion T.; Kanekiyo, Takahisa; Vishnu, Prakash; Zubair, Abba C.; Raper, Carol; Tawk, Rabih G.; Freeman, William D.

doi:10.1016/j.jstrokecerebrovasdis.2019.104631

Cited by 30 publications

(26 citation statements)

References 11 publications

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“…No surgical treatment for aneurysm was undertaken in 32 (7%), and no aneurysm was found in 58 (13%). Subjects who developed DCI had higher mFS scores [mFS ≥3: 232 (64%) vs. 75 (85%), P < 0.001], higher proportion of IVH [173 (48%) vs. 67 (76%), P < 0.001], higher frequency of aneurysm clipping [101 (28%) vs. 38 (43%), P = 0.041], worse outcomes [mRS ≥4: 97 (27%) vs. 49 (56%), P < 0.001], and longer hospital length of stay [12 days (IQR 9, 16) vs. 19 days ( 14 , 24 ), P < 0.001]. Subjects with poor outcomes (mRS ≥4) were older [age 51 (IQR 42, 59) vs. 61 ( 31 , 32 ), P < 0.001], had a higher proportion of hypertension [197 (65%) vs. 107 (73%), P = 0.004], had higher HH grade [HH 4,5: 21 (6.9%) vs. 74 (51%), P < 0.001], had higher mFS scores [mFS ≥3: 186 (61%) vs. 121 (83%), P < 0.001], had a higher proportion of IVH [133 (44%) vs. 107 (73%), P < 0.001], had a higher incidence of DCI [39 (13%) vs. 49 (34%), P < 0.001], and had a higher hospital length of stay [12 days (IQR 9, 16) vs. 16 days (IQR 8, 23), P < 0.001].…”

Section: Resultsmentioning

confidence: 99%

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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Objective: Systemic inflammation after subarachnoid hemorrhage (SAH) is implicated in delayed cerebral ischemia (DCI) and adverse clinical outcomes. We hypothesize that early changes in peripheral leukocytes will be associated with outcomes after SAH.Methods: SAH patients admitted between January 2009 and December 2016 were enrolled into a prospective observational study and were assessed for Hunt Hess Scale (HHS) at admission, DCI, and modified Ranked Scale (mRS) at discharge. Total white blood cell (WBC) counts and each component of the differential cell count were determined on the day of admission (day 0) to 8 days after bleed (day 8). Global cerebral edema (GCE) was assessed on admission CT, and presence of any infection was determined. Statistical tests included student's t-test, Chi-square test, and multivariate logistic regression (MLR) models.Results: A total of 451 subjects were analyzed. Total WBCs and neutrophils decreased initially reaching a minimum at day 4–5 after SAH. Monocyte count increased gradually after SAH and peaked between day 6–8, while basophils and lymphocytes decreased initially from day 0 to 1 and steadily increased thereafter. Neutrophil to lymphocyte ratio (NLR) reached a peak on day 1 and decreased thereafter. WBCs, neutrophils, monocytes, and NLR were higher in patients with DCI and poor functional outcomes. WBCs, neutrophils, and NLR were higher in subjects who developed infections. In MLR models, neutrophils and monocytes were associated with DCI and worse functional outcomes, while NLR was only associated with worse functional outcomes. Occurrence of infection was associated with poor outcome. Neutrophils and NLR were associated with infection, while monocytes were not. Monocytes were higher in males, and ROC curve analysis revealed improved ability of monocytes to predict DCI and poor functional outcomes in male subjects.Conclusions: Monocytosis was associated with DCI and poor functional outcomes after SAH. The association between neutrophils and NLR and infection may impact outcomes. Early elevation in monocytes had an improved ability to predict DCI and poor functional outcomes in males, which was independent of the occurrence of infection.

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Section: Resultsmentioning

confidence: 99%

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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“…The results of histopathology found that the thinned wall of aneurysms was related to leukocytosis 39 . Furthermore, Sheheryar et al mentioned that elevated NLR at admission could predict higher inpatient mortality among aSAH patients 40 . Giede‐Jeppe et al 29 reported NLR as an independent factor for unfavorable functional outcome in aSAH.…”

Section: Discussionmentioning

confidence: 99%

“…39 Furthermore, Sheheryar et al mentioned that elevated NLR at admission could predict higher inpatient mortality among aSAH patients. 40 Giede-Jeppe et al 29 reported NLR as an independent factor for unfavorable functional outcome in aSAH. These were consistent with our findings, indicating the high level of NLR may increase the risk of poor prognosis in patients with aSAH.…”

Section: F I G U R E 2 Roc Curve Of the Prognosis In Patients With Aashmentioning

confidence: 99%

Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage

Zhang

et al. 2020

Clinical Laboratory Analysis

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Aneurysmal subarachnoid hemorrhage (aSAH) is an acute cerebrovascular disease that seriously damages the central nervous system and simultaneously exerts pathophysiological effects on multiple organs of the body, with high mortality and morbidity. 1,2 Approximately onethird of the survivors suffer from severe disability and functional dependency. 3 Rebleeding is a major early complication of aSAH with the incidence of 6%-23%, which most occurs within 72 hours of onset. 4,5 Previous studies reported that the mortality was 50%-60% in the presence of rebleeding. 4-6 To date, craniotomy clipping and endovascular embolization serve as main treatments for aSAH to prevent and treat complications such as rebleeding, vasospasm and hydrocephalus, and to reduce the occurrences of deaths and disabilities. 7-11 Although improvements in intensive care and treatments in recent years, the prognosis is still a frequent concern for aSAH. To the best of our knowledge,

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“…Jamali et al found that the NLR value of patients who died in the hospital was significantly higher than that of surviving patients, and the in-hospital mortality rate of patients with an NLR ≥12.5 increased significantly. In this study, the effects of the absolute neutrophil count and absolute lymphocyte count on mortality were compared separately, and the results showed that there was no difference ( 72 ). Yilmaz et al also found that the NLR was associated with the Fisher score and mortality and was a simple indicator of aSAH patient severity and short-term mortality ( 79 ).…”

Section: Clinical Evidencementioning

confidence: 99%

“…Patients with a high NLR are more likely to develop pneumonia during hospitalization ( 113 ), and an NLR ≥5.9 is associated with pulmonary edema and high fever ( 74 ). The average number of neutrophils in patients with pneumonia is significantly increased ( 72 ). In particular, patients with DCI have a higher NLR and are more likely to be infected at a later stage ( 76 ).…”

Section: Practice Prospectsmentioning

confidence: 99%

The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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Aneurysmal subarachnoid hemorrhage (aSAH) is an important type of stroke with the highest rates of mortality and disability. Recent evidence indicates that neuroinflammation plays a critical role in both early brain injury and delayed neural deterioration after aSAH, contributing to unfavorable outcomes. The neutrophil-to-lymphocyte ratio (NLR) is a peripheral biomarker that conveys information about the inflammatory burden in terms of both innate and adaptive immunity. This review summarizes relevant studies that associate the NLR with aSAH to evaluate whether the NLR can predict outcomes and serve as an effective biomarker for clinical management. We found that increased NLR is valuable in predicting the clinical outcome of aSAH patients and is related to the risk of complications such as delayed cerebral ischemia (DCI) or rebleeding. Combined with other indicators, the NLR provides improved accuracy for predicting prognosis to stratify patients into different risk categories. The underlying pathophysiology is highlighted to identify new potential targets for neuroprotection and to develop novel therapeutic strategies.

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Elevated Neutrophil-Lymphocyte Ratio is Predictive of Poor Outcomes Following Aneurysmal Subarachnoid Hemorrhage

Cited by 30 publications

References 11 publications

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Time Course of Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Development and validation of a predictive model for the prognosis in aneurysmal subarachnoid hemorrhage

The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage

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