Neutrophil to lymphocyte ratio – A novel prognostic marker following spontaneous intracerebral haemorrhage

Menon, Girish; Johnson, Sarah Estar; Hegde, Ajay; Rathod, Sanjeev; Nayak, Raghavendra; Nair, Rajesh

doi:10.1016/j.clineuro.2020.106339

Cited by 26 publications

(25 citation statements)

References 33 publications

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“…Underlying immunopathological mechanisms, particularly concerning BBB damage, are similar to those in cerebral ischemia, making NLR use in AIS patients promising. Similar predictive value has been found in intracerebral hemorrhage (ICH) 44,45 and multi‐trauma patients, 46 and even in Coronavirus Disease 2019 (COVID‐19) patients, 47 now known to be a multisystem disease with immune underpinnings 48 . Spatial and temporal variations in neutrophils and lymphocytes, discussed earlier, are the basis for NLR's use, wherein lymphocytes are lower peripherally post‐stroke and higher in the central nervous system (CNS), and neutrophils increase in both periphery and CNS, with this manifesting as increased NLR 36 …”

Section: Methodsmentioning

confidence: 63%

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Neutrophil–lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis

2021

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There is an ongoing need for accurate prognostic biomarkers in the milieu of acute ischemic stroke (AIS) receiving reperfusion therapy. Neutrophil–lymphocyte ratio (NLR) has been implicated in emergency medicine and acute stroke setting as an important biomarker in the prognosis of patients. However, there are ongoing questions around its accuracy and translation into clinical practice given suboptimal sensitivity and specificity results, as well as varying thresholds and lack of clarity around which NLR time points are most clinically indicative. This article provides a comprehensive overview of the role of NLR in AIS patients receiving reperfusion therapy and perspectives on areas of future research. NLR may be an important biomarker in risk stratifying patients in AIS to identify and select those who are more likely to benefit from reperfusion therapy. Appropriate clinical decision‐making tools and models are required to harness the predictive value of NLR, which could be useful in identifying and monitoring high‐risk patients to guide early treatment and achieve improved outcomes. Our understanding of the role of NLR in the immunopathogenesis of AIS is also suboptimal, which hinders the ability to translate this into clinical practice.

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Section: Methodsmentioning

confidence: 63%

“…Broadly speaking, increasing evidence indicates a prognostic role of NLR in predicting clinical course, not just of ischemic stroke, 17,49 but also of hemorrhagic stroke 44,62 . Considering these findings, it is postulated that inflammatory pathways may underpin secondary brain injury in acute cerebrovascular conditions 45 …”

Section: Discussionmentioning

confidence: 99%

Neutrophil–lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis

2021

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“…NLR refers to the Neutrophil-to-Lymphocyte Ratio and has gained interest in the recent years as a biomarker of inflammation. Previous studies have indicated that NLR is a predictor for unfavorable functional outcome after AIS and ICH, but the underlying mechanisms remain indefinite (26)(27)(28). The occurrence of AIS results in an increase in neutrophil counts (an activation of neutrophils), and a decrease in lymphocyte counts due to the post-stroke immunodepression (29), activated by the sympathetic nervous system and hypothalamic-pituitary-adrenal axis (30).…”

Section: Discussionmentioning

confidence: 99%

Prognosis and Predictors of Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Large Vessel Occlusion Stroke

Shen

Ma²,

Chen³

et al. 2022

Front. Neurol.

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BackgroundSymptomatic intracranial hemorrhage (sICH) is a devastating complication of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) and is associated with high risk of disability and mortality. This study intended to evaluate the predictors of sICH after EVT in patients with large vessel occlusion (LVO)-induced AIS.MethodsWe conducted a retrospective review on consecutive AIS patients who underwent EVT in our University hospital between January 2019 and August 2020. The patients were classified into two groups based upon the occurrence of sICH. The main outcomes were the occurrence of sICH using the Heidelberg Bleeding Classification and functional condition at 90 days. Multivariate logistic regression analysis and receiver operating characteristics (ROC) curves were used to identify independent predictors of sICH after EVT.ResultsThree hundred and 69 patients were enrolled in the study, of which 16.8% (n = 62) developed sICH. Favorable neurological outcome was lower in patients with sICH than in patients without sICH (6.5 vs. 43.3%; P < 0.001), with the overall mortality being 112 (30.4%) at 90 days post- EVT. Results from univariate analysis showed significant differences between the two groups in the prevalence of diabetes, initial Alberta Stroke Program Early CT Score (ASPECTS) score, National Institutes of Health Stroke Scale (NIHSS) score after operation, the levels of fasting blood glucose (FBG), neutrophil to lymphocyte ratio (NLR), platelets (PLT), and thrombin time (TT) at admission. Multivariate logistic regression analysis showed that FBG ≥ 7.54 mmol/L (OR: 2.765; 95% confidence interval [CI]: 1.513–5.054), NLR ≥ 5.48 (OR: 2.711; 95% CI: 1.433–5.128), TT at admission ≥ 16.25 s (OR: 2.022; 95% CI: 1.115–3.667), and NIHSS score within 24 h after the operation ≥ 10 (OR: 3.728; 95% CI: 1.516–9.170) were independent predictors of sICH. The combination of NLR ≥ 5.48, FBG ≥ 7.54 mmol/L, TT at admission ≥ 16.25 s, and NIHSS score within 24 h after the operation ≥ 10 generated an optimal prediction model (AUC: 0.723).ConclusionHigher levels of FDG, NLR, TT at admission, and NIHSS score after operation were associated with sICH after EVT in patients with LVO-induced AIS.

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“…First, we excluded 239 duplicates, then an additional 323 studies after screening the titles and abstracts; subsequently, 61 studies remained to undergo full-text review. Finally, we included 26 studies with 7,317 patients in the final analysis ( Lattanzi et al, 2016 , 2017 , 2018 ; Wang et al, 2016 ; Giede-Jeppe et al, 2017 ; Seabra et al, 2017 ; Sun et al, 2017 ; Tao et al, 2017 ; Fan et al, 2018 ; Qi et al, 2018 ; Wang F. et al, 2018 , 2019 ; Zhang et al, 2018a , b , 2019a , b , 2019c ; Guo et al, 2019 ; Pektezel et al, 2019 ; Qin et al, 2019 ; Wang Z. et al, 2019 ; Chen et al, 2020 ; Fonseca et al, 2021 ; Menon et al, 2021 ; Mohamed et al, 2021 ; Radu et al, 2021 ), of which 14 studies reported the prognostic value of NLR for poor outcome, 12 studies reported the prognostic value of NLR for mortality, four studies reported the prognostic value of NLR for hematoma expansion, and three studies reported the prognostic value of NLR for neurological deterioration, respectively.…”

Section: Resultsmentioning

confidence: 99%

Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Shi

Zhang

et al. 2022

Front. Neurosci.

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The neutrophil-to-lymphocyte ratio (NLR) plays an important role in the progression of intracerebral hemorrhage (ICH). An increasing number of studies have reported that a high NLR is correlated with poor clinical outcomes among patients with ICH. Here, we conducted a systematic review and meta-analysis to evaluate the prognostic value of NLR in the setting of ICH. We performed a comprehensive search of electronic literature databases to identify all relevant studies evaluating the prognostic role of NLR in patients with ICH. Two researchers independently screened the studies and extracted relevant data. We extracted, pooled, and weighted odds ratio (OR) and 95% confidence interval (CI) values using a generic inverse-variance method, and then evaluated the heterogeneity among studies using Q test and I2 statistic. Finally, we selected a total of 26 studies including 7,317 patients for the current study. Overall, our results indicated that a high NLR was significantly associated with a poor outcome (OR, 1.32; 95% CI, 1.19–1.46; P < 0.00001), mortality (OR, 1.05; 95% CI, 1.01–1.09; P = 0.02), and neurological deterioration (OR, 1.65; 95% CI, 1.08–2.52; P = 0.02). We did not observe a significant association between NLR and hematoma expansion (OR, 1.04; 95% CI, 0.99–1.08; P = 0.09). Our study indicated that a high NLR is significantly associated with poor clinical outcomes in patients with ICH. As NLR is a simple and easily available biomarker, future studies should focus on exploring its application in the prognostic evaluation of patients with ICH.

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Neutrophil to lymphocyte ratio – A novel prognostic marker following spontaneous intracerebral haemorrhage

Cited by 26 publications

References 33 publications

Neutrophil–lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis

Neutrophil–lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis

Prognosis and Predictors of Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Large Vessel Occlusion Stroke

Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

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