&lt;p&gt;The association of neutrophil-to-lymphocyte ratio and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage: possible involvement of cerebral blood perfusion&lt;/p&gt;

Wu, Yue; He, Qiuguang; Wei, Yue; Zhu, Jianhua; He, Zhaohui; Zhang, Xiaodong; Guo, Zongduo; Xu, Rui; Cheng, Chung–Ying; Huang, Zhijian; Sun, Xiaochuan

doi:10.2147/ndt.s190477

Cited by 34 publications

(30 citation statements)

References 23 publications

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“…Only four studies [ 16 , 24 , 26 , 27 ] provided enough data of peripheral WBC and were included in the meta-analysis to determine the associations between early elevated WBC and occurrence of DCI. Substantial heterogeneity was found among the four studies ( Q statistic = 13.691, I 2 = 78.089%, P = 0.003).…”

Section: Resultsmentioning

confidence: 99%

“…It is known that the need for special laboratory test or collection of CSF sample limits the clinical utility of a biomarker, and this highlights the need for searching for a quick, sensitive and safe biomarker which is easy to obtain for evaluating prognosis in aSAH. In addition, there is increasing evidence on the role of inflammation in the pathogenesis of DCI and poor outcomes following aSAH [ 27 ]. Among the common readily available markers for systemic inflammation, many studies have investigated the independent role of early increase in CRP and WBC as risk factors for unfavorable outcomes after aSAH.…”

Section: Discussionmentioning

confidence: 99%

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Associations between C-reactive protein and white blood cell count, occurrence of delayed cerebral ischemia and poor outcome following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Zhang

2021

Acta Neurol Belg

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This review and meta-analysis investigated associations of systemic inflammatory marker C-reactive protein (CRP) and white blood cell count (WBC) with occurrence of delayed cerebral ischemia (DCI) and poor functional outcome after aneurysmal subarachnoid hemorrhage (aSAH). Pubmed, EMBASE, and CENTRAL databases were searched until November 30, 2019, selecting prospective and retrospective studies of patients with spontaneous SAH due to ruptured aneurysm. Outcome measures were occurrence of DCI, defined as new focal neurological deficit or a deterioration of consciousness; and/or a new infarct on computed tomography or magnetic resonance imaging that was not visible initially. Occurrence of poor functional outcome at follow-up were measured by modified Rankin Scale or Glasgow outcomes scale. Fifteen studies analyzing data of 3268 patients with aSAH were included. Meta-analysis revealed early increase in CRP was significantly associated with higher risk of occurrence of DCI (pooled OR 1.30, 95% CI 1.10-1.54; P = 0.002), whereas not with poor functional outcome (pooled OR 1.02, 95% CI 1.00-1.04, P = 0.052). No significant associations between early increase in WBC and DCI (pooled OR 1.13, 95% CI 0.95-1.34; P = 0.179) were observed, whereas increase in WBC was significantly associated with increased risk of poor functional outcome (pooled OR 1.17, 95% CI 1.07-1.28, P = 0.001). Early increase in blood CRP appears to correlate with DCI after SAH, while increase in WBC correlates with poor functional outcome. However, strong conclusion cannot be made due to the small study number, between-study heterogeneity and suspicion of uncontrolled factors. Whether early phase CRP and WBC may serve as prognostic markers for aSAH needs more investigation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Associations between C-reactive protein and white blood cell count, occurrence of delayed cerebral ischemia and poor outcome following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Zhang

2021

Acta Neurol Belg

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“…NLR has previously been reported to be useful as a prognostic factor in acute ischemic stroke and transient ischemic attack [36,37]. Recently, Wu et al reported that leukocytosis may be regarded as an early pathology of subarachnoid hemorrhage and that NLR may be used as a practical predictor for the occurrence of delayed cerebral ischemia in those patients [38]. A disturbance in peripheral blood lymphocyte subsets has been described to be associated with complications in high-risk vascular patients [39].…”

Section: Discussionmentioning

confidence: 99%

Could Neutrophil-to-Lymphocyte Ratio (NLR) Serve as a Potential Marker for Delirium Prediction in Patients with Acute Ischemic Stroke? A Prospective Observational Study

Kotfis

Bott-Olejnik²,

Szylińska

et al. 2019

JCM

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Delirium is an acute brain disorder that commonly occurs in patients with acute ischemic stroke (AIS). Pathomechanism of delirium is related to the neuroinflammatory process and oxidative stress. Search for readily available diagnostic marker that will aid clinicians in early identification of delirium is ongoing. The aim of this study was to investigate whether neutrophil-to-lymphocyte ratio (NLR) could serve as a potential marker for delirium prediction in patients with AIS and to find an easy diagnostic tool using laboratory and clinical parameters to predict delirium. Prospective observational study (NCT03944694) included patients with AIS admitted to the neurology department of a district general hospital. All patients were screened for delirium using CAM-ICU (Confusion Assessment Method for Intensive Care Unit). Demographic and medical history data and admission lab results, including differential white blood cell analysis, were collected from all patients. We included 1001 patients in the final analysis. The mean age of the sample was 71 years, and 52% of patients were males. The incidence of early-onset delirium was 17.2%. The NLR was elevated in delirious patients (6.39 ± 8.60 vs. 4.61 ± 5.61, p < 0.001). The best cut-off value of NLR to predict delirium using the receiver operating characteristics (ROC) was determined at 4.86. Multivariable logistic regression analysis showed that the odds ratio (OR) for developing delirium with NLR > 4.86 (adjusted for age, sex, body mass index (BMI), comorbidities, and baseline neurology) was 1.875 (95% CI 1.314–2.675, p = 0.001). As a result of different combinations of markers and clinical parameters based on logistic regression, a formula—DELirium in Acute Ischemic Stroke (DELIAS score)—was obtained with the area under the ROC curve of 0.801 (p < 0.001). After regression of the cut-off points of the obtained curve, a significant correlation of the DELIAS score was observed with the occurrence of early-onset delirium (OR = 8.976, p < 0.001) and with delirium until the fifth day after AIS (OR = 7.744, p < 0.001). In conclusion, NLR can be regarded as a potential marker for prediction of early-onset delirium after AIS. On the basis of combined laboratory and clinical parameters, the DELIAS score was calculated, which gave the highest predictive value for delirium in the analyzed group of patients after ischemic stroke. However, further studies are needed to validate these findings.

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“…These are enzymes able to degrade any component of the extracellular matrix and play role in brain‐barrier damage and development of secondary brain injury 27 . In addition, the mechanism of NLR‐induced bleeding may be contributed by multifactorial pathophysiology, such as inflammatory reaction, immune dysfunction, and the production of reactive oxygen species (ROS) 5,28‐32 . aSAH can induce the leukocytosis and increased neutrophils by stimulating the systemic cellular responses that can cause the brain injury and delayed cerebral ischemia 33,34 .…”

Section: Discussionmentioning

confidence: 99%

“…27 In addition, the mechanism of NLRinduced bleeding may be contributed by multifactorial pathophysiology, such as inflammatory reaction, immune dysfunction, and the production of reactive oxygen species (ROS). 5,[28][29][30][31][32] aSAH can induce the leukocytosis and increased neutrophils by stimulating the systemic cellular responses that can cause the brain injury and delayed cerebral ischemia. 33,34 Early studies showed that the growth and rupture of cerebral aneurysms were promoted via the leukocyte infiltration and inflammatory reaction in the wall of aneurysms.…”

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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<p>The association of neutrophil-to-lymphocyte ratio and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage: possible involvement of cerebral blood perfusion</p>

Cited by 34 publications

References 23 publications

Associations between C-reactive protein and white blood cell count, occurrence of delayed cerebral ischemia and poor outcome following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Associations between C-reactive protein and white blood cell count, occurrence of delayed cerebral ischemia and poor outcome following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Could Neutrophil-to-Lymphocyte Ratio (NLR) Serve as a Potential Marker for Delirium Prediction in Patients with Acute Ischemic Stroke? A Prospective Observational Study

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

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