Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage

Abstract

S pontaneous intracerebral hemorrhage (ICH) accounts for 10% to 30% of all strokes and is characterized by high rates of mortality and disability. The inflammatory response contributes to the ICH-induced secondary brain injury although the mechanisms are unknown. 1 The aim of this study was to evaluate the relationships between the total and differential leukocyte counts and the neutrophil-to-lymphocyte ratio (NLR) at admission with the 3-month outcome in ICH patients. Methods Participants and Study OutcomeWe retrospectively identified consecutive patients hospitalized at the Stroke Unit of the Marche Polytechnic University, Ancona, Italy from January 2008 to September 2015 for stroke syndrome caused by acute spontaneous ICH who underwent admission routine blood sampling and cranial computed tomographic neuroimaging within 24 hours from symptom onset. Demographics, medical history, admission/discharge National Institutes of Health Stroke Scale 2 scores, baseline ICH topography and volume, 3 admission blood pressure and 24-hour blood pressure variability by means the coefficient of variation 4 were considered. Total white blood cells (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and erythrocyte sedimentation rate were collected from admission blood work. The outcome measure was the 3-month functional status: poor outcome was the occurrence of death or major disability (modified Rankin Scale score, ≥3). 5 Statistical AnalysisValues are presented as mean±SD, median (interquartile range) or number (%) of subjects. Comparisons were made through the Student t test, Mann-Whitney U test or χ 2 test. Spearman correlation was used to correlate continuous variables. The associations between the WBC, ANC, ALC, NLR, and the study end point were determined using the logistic regression; the variables with P<0.05 from comparison of baseline characteristics and selected variables (age, sex, initial National Institutes of Health Stroke Scale score, baseline volume, location, and intraventricular extension of ICH) 6 were forced into the multivariate analysis. The analysis was performed after categorization of the WBC, ANC, and ALC values into higher and lower groups with respect to the normal reference ranges. 7 The receiver operating characteristic analysis evaluated the ability of the WBC, ANC, ALC, and NLR to predict the outcome. Results were significant for P<0.05 (2 sided). Analysis was performed using STATA/IC 13.1 (StataCorp LP, TX). Standard Protocol ApprovalsThe local ethical committee approved this study. The board allowed the study to be conducted without patients' consent because of the retrospective nature of the study. ResultsA total of 177 patients were recruited, whose 94 (53.1%) had a modified Rankin Scale score of ≥3 at 3 months (Table 1). The poor outcome patients had higher WBC, ANC, and NLR and lower ALC (Table I in the online-only Data Supplement); no difference was found in the admission erythrocyte sedimentation rate values (28±2 versus 26±2 mm/h for good and poor outcome, respec...

Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage

“…Inflammation plays an important role in cerebrovascular diseases [1][2][3][4] , including intracerebral hemorrhage (ICH) [5][6][7] and is usually monitored using a variety of biochemical and hematological markers [8][9][10][11][12] . Neutrophil-to-lymphocyte ratio (NLR), calculated by the absolute neutrophil count divided by the absolute lymphocyte count, is increasingly recognized as a readily available and inexpensive biomarker for systemic inflammation [13] .…”

Response by Lattanzi and Silvestrini to Letter Regarding Article, “Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage”

“…2 We agree that medical conditions such as premorbid atherosclerotic disease, underlying inflammation, and intercurrent infections could have influenced the NLR and partly accounted for its association with outcome. The prevalence of all the major cardiovascular risk factors such as smoking, dyslipidemia, diabetes mellitus, or hypertension, however, did not significantly differ among the outcome groups, and correlations did not emerge between age and NLR.…”

Admission Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratio as a predictor of mortality in patients with Subarachnoid Hemorrhage

“…NLR and PLR are novel composite inflammatory markers in the area of vascular pathologies including cerebral iscemia, intracerebral hemorrhage, venous thromboembolism (10,11,17). It has been also shown that increased platelet activation plays an important role in the initiation and progression of atherosclerosis.…”

“…NLR was found to be associated with outcome of intracerebral hemorrhage, SAH (10,11) and cerebral ischemia (12) and PLR with myocardial infarction (13) and peripheral ischemia (14). It is well-known that systematic inflammation and hypercoagulation contribute to the worse clinical outcome of SAH.…”