Neutrophil-to-Lymphocyte Ratio and Prognosis of Spontaneous Intracerebral Hemorrhage

Abstract

INTRODUCTION: Neutrophil to Lymphocyte Ratio (NLR) is suggested to predict functional outcomes and mortality at admission of patients with intracerebral hemorrhage (ICH). However, effect of timing of NLR measurement on prediction of mortality and expansion in ICH has not been clarified. METHODS: From admission and 24th-hour blood samples, admission NLR (NLR-adm) and 24th-hour NLR (NLR-24th) was calculated as "absolute neutrophil count/lymphocyte count". Hematoma expansion was evaluated with the volume (ABC/2) difference from admission cranial CT to follow-up one. RESULTS: A total of 383 patients (41.7% female, age, 65±13) were assessed. Of them, 251 (65.5%) were discharged. The average hematoma volume was 32.8 cc and 35.3 cc in the first and second CT, respectively. The mean NLR was 8.2±10.3 at admission and 16.6 ± 15.7 at 24th hour. Only NLR-24th (β=0.035, OR: 1.036 (1.002-1.071), p=0.04), hematoma volume at first CT (β=0.012, OR 1.012 (0.999-1.024) p=0.067) and Hemphill score (β=0.689, OR 1.992 (1.402-2.832) p<0.001) were found to be significantly related with mortality after adjusted to age (decade), atrial fibrillation, anticoagulant use and NLR-adm. An exploratory logistic regression analysis indicated that hematoma expansion greater than 12.5 cc correlated to, albeit borderline, NLR-24th (β=0.038, OR=1.038 (95%CI: 1.008-1.069) but not NLR-adm. DISCUSSION and CONCLUSION: We found NLR-24th to be associated with higher mortality and greater hematoma expansion rate. This NLR increment, probably secondary to the stress response, in ICH can be considered as an epiphenomenon of worse prognosis.

Comparison of stroke cases with other neurological diseases on the basis of haemogram parameters

“…16 Many studies have observed similar mechanisms in subarachnoid and intraparenchymal haemorrhages. 17,18 In our study, in line with the findings in the literature, while leukocytosis, neutrophilia and lymphopenia were detected in the stroke group compared with the non-stroke group, a statistically significant increase in the NLR was also found (P < .001).…”

“…[10][11][12][13]15,17,18,26 There is not enough evidence to explain the relationship between the NLR values evaluated after the first 24 hours and the patient's clinical situation, and the available evidence is thought to contain bias in many aspects. 10,17,18,26,31…”

“…In our study, blood samples were taken within the first 24 hours and evaluated. In studies conducted in the literature, blood was taken within 6‐24 hours and the samples obtained were then evaluated 10‐15,17,18,26 . In the results of these studies, patients with high NLR rates in the data obtained from blood taken in the first 24 hours were associated with high mortality rates or poor clinical outcomes 10‐13,15,17,18,26 .…”

“…In studies conducted in the literature, blood was taken within 6‐24 hours and the samples obtained were then evaluated 10‐15,17,18,26 . In the results of these studies, patients with high NLR rates in the data obtained from blood taken in the first 24 hours were associated with high mortality rates or poor clinical outcomes 10‐13,15,17,18,26 . There is not enough evidence to explain the relationship between the NLR values evaluated after the first 24 hours and the patient's clinical situation, and the available evidence is thought to contain bias in many aspects 10,17,18,26,31 …”

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

“…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.…”