Neutrophil to lymphocyte ratio predicting poor outcome after aneurysmal subarachnoid hemorrhage: A retrospective study and updated meta-analysis

Abstract

BackgroundThe relationship between neutrophil to lymphocyte ratio (NLR) and poor outcome of aneurysmal subarachnoid hemorrhage (aSAH) is controversial. We aim to evaluate the relationship between NLR on admission and the poor outcome after aSAH.MethodPart I: Retrospective analysis of aSAH patients in our center. Baseline characteristics of patients were collected and compared. Multivariate analysis was used to evaluate parameters independently related to poor outcome. Receiver operating characteristic (ROC) curve analysis was used to determine the best cut-off value of NLR. Part II: Systematic review and meta-analysis of relevant literature. Related literature was selected through the database. The pooled odds ratio (OR) and corresponding 95% confidence interval (CI) were calculated to evaluate the correlation between NLR and outcome measures.ResultsPart I: A total of 240 patients with aSAH were enrolled, and 52 patients had a poor outcome. Patients with poor outcome at 3 months had a higher admission NLR, Hunt & Hess score, Barrow Neurological Institute (BNI) scale score, Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), and proportion of hypertension history. After adjustment, NLR at admission remained an independent predictor of poor outcome in aSAH patients (OR 0.76, 95% CI 0.69-0.83; P < 0.001). The best cut-off value of NLR in ROC analysis is 12.03 (area under the curve 0.805, 95% CI 0.735 - 0.875; P < 0.001). Part II: A total of 16 literature were included. Pooled results showed that elevated NLR was significantly associated with poor outcome (OR 1.31, 95% CI 1.14-1.49; P < 0.0001) and delayed cerebral ischemia (DCI) occurrence (OR 1.32, 95% CI 1.11-1.56; P = 0.002). The results are more reliable in large sample sizes, low NLR cut-off value, multicenter, or prospective studies.ConclusionElevated NLR is an independent predictor of poor outcome and DCI occurrence in aSAH.

Monitoring of Perioperative Microcirculation Dysfunction by Near-Infrared Spectroscopy for Neurological Deterioration and Prognosis of Aneurysmal Subarachnoid Hemorrhage: An Observational, Longitudinal Cohort Study

“…According to the laboratory findings, previous research has shown that inflammatory/immunologic reactions markedly influence outcomes and predict the clinical course of stroke [ 46 , 47 ]; in particular, the neutrophil-to-lymphocyte ratio [NIR] has received increased amounts of attention [ 22 , 48 , 49 ]. This study was similar to multiple other studies and showed that NIR radiation is significantly associated with adverse functional outcomes in patients with aSAH, but this association was no longer significant after stepwise regression analysis [ 31 , 50 ].…”

Neutrophil-to-lymphocyte ratio predicted cerebral infarction and poor discharge functional outcome in aneurysmal subarachnoid hemorrhage: A propensity score matching analysis

“…Based on the results of our literature search and several systematic reviews,[ 12 , 17 , 24 ] our study was the first to evaluate the association of NLR and PLR with aSAH in a Southeast Asian population. We demonstrated the association between admission NLR with cerebral infarction.…”

“…reported a cutoff value of 7.05 for predicting poor 3-month functional outcome, the closest to our reported cutoff value. [ 12 ] Although they did not specifically describe the racial characteristics of their study population, it could be deduced from their study location in Germany that they were mainly Caucasian. [ 11 ] Nevertheless, it is too early to conclude that the Southeast Asian people’s NLR value is comparable to those of the Caucasian’s.…”

Preoperative inflammatory markers predict postoperative clinical outcomes in patients undergoing heart valve surgery: A large-sample retrospective study

“…C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) are commonly used objective inflammatory biomarkers. Previous studies have demonstrated their predictive effects on the outcomes of aneurysmal subarachnoid hemorrhage (13), cancer (14), and perioperative myocardial injury in non-cardiac surgery patients (15). However, to date, the prognostic role of these preoperative inflammatory markers in heart valve surgery under cardiopulmonary bypass (CBP) has not been synthetically investigated, highlighting a need for research on the topic.…”