The use of neutrophil to lymphocyte ratio as a predictor for clinical outcomes in spontaneous intracerebral hemorrhage

Abstract

ObjectiveNeutrophil to lymphocyte ratio (NLR) is used as an independent predictor for clinical outcomes in cancers, cardiovascular disorders and ischemic stroke. The prognostic role of NLR in spontaneous intracerebral hemorrhage (sICH) is still controversial. The aim of this report is to conduct a meta-analysis to evaluate the prognostic significance NLR in patients with sICH.Materials and MethodsAll related articles were searched on PubMed, EMBASE, Cochrane Central Register of Controlled Trials followed the PRISMA flow diagram. The quality of eligible studies were evaluated and the related data were extracted by two reviewers independently. The end points included the mortality and poor outcomes and subgroup analyses were performed.ResultsFive studies with 1944 subjects were included and had acceptable quality. The high NLR had a higher risk of in-hospital mortality (OR: 0.97; 95% CI: 0.94–0.99, p = 0.02) and 90-day mortality (OR: 2.43; 95% CI: 1.01–5.83, p = 0.047); without association with the poor outcomes (OR: 1.17; 95% CI: 0.93–1.47, p = 0.18). After subgroup analyses, the high NLR correlated with an increased 90-day mortality in the high cut-off group (OR: 1.56; 95% CI: 1.15–2.13, p = 0.005). The high NLR additionally predicts poor outcomes in smaller hematoma group (OR: 1.16; 95% CI: 1.01–1.32, p = 0.04) and the high cut-off group (OR: 2.20; 95% CI: 1.54–3.14, p < 0.001).ConclusionsThe high NLR was significantly associated with in-hospital and 90-day mortality in patients with sICH. The NLR with cut-off of 7.5 had statistically significant potential for predicting mortality and poor outcomes, regardless of country, time of laboratory test and hematoma volumes.

Neutrophil‐to‐lymphocyte ratio predicts hemorrhagic transformation in ischemic stroke: A meta‐analysis

“…Inflammation is considered a major player in the development of secondary brain injury after stroke (Qun et al, ; Ye et al, ). The neutrophil‐to‐lymphocyte ratio has been recognized as a simple and reliable inflammatory marker (Zahorec, ).…”

“…Our target is determining the best NLR predictors. The cutoff values for various diseases vary; for example, the symptomatic intracranial hemorrhage (sICH) has a value of 4.08–7.35 (Ye et al, ), and cardiovascular disease has a value of 3.5–7.6 (Bhat et al, ). In one of the articles we included, Malhotra et al () did not perform a regression analysis on the predictive value of NLR in patients with AIS, and we excluded it.…”

“…Inflammation is considered a major player in the development of secondary brain injury after stroke (Qun et al, 2017;Ye et al, 2017).…”

Early increased neutrophil-to-lymphocyte ratio is associated with poor 3-month outcomes in spontaneous intracerebral hemorrhage

“…However, we found that NLR1, NLR3, and NLR7 were not independently predictive of 3-month outcomes. A recent meta-analysis assessed the prognostic role of NLR in patients with sICH and concluded it is time-dependent, with values increasing over the first few days [45]. Conversely, Sun et al [24] have reported that NLR at admission is not associated with 3-month outcomes post-ICH, possibly due to a single NLR measurement on admission, different risk factors, heterogeneity, and regional disparity.…”

Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis

“…Blood leukocyte and neutrophil counts are conventional inflammatory markers. Recently, it is found that neutrophil to lymphocyte ratio (NLR) is a diverse functional prognosis predictor in some diseases, such as myocardial infarction, adult polymyositis and dermatomyositis, and spontaneous intracerebral hemorrhage [15][16][17]. NLR is related to immune dysregulation in patients with cirrhosis and is inexpensive to measure.…”