Association Between the Neutrophil-to-Lymphocyte Ratio and Adverse Clinical Prognosis in Patients with Spontaneous Intracerebral Hemorrhage

Abstract

Yang Du,1,2 Anxin Wang,1,2 Jia Zhang,1,2 Xiaoli Zhang,2 Ning Li,1,2 Xinmin Liu,1,2 Wenjuan Wang,1,2 Xingquan Zhao,1– 4 Liheng Bian1,2 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People’s Republic of China; 3Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 4Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of ChinaCorrespondence: Liheng Bian; Xingquan Zhao, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, 100070, People’s Republic of China, Tel [phone], Email [email protected]; [email protected]: The neutrophil-to-lymphocyte ratio (NLR) is an index reflecting the overall inflammatory and stress status of patients with major diseases. Many studies associated the NLR with neurological deterioration and a poor prognosis in the spontaneous intracerebral hemorrhage (ICH). However, most previous studies did not further analyze NLR by stratification, and with a relatively small sample size. Besides, the outcome evaluation mostly focused on short-term prognosis or a single timepoint.Methods: Patients’ basic characteristics and laboratory examination results, including the NLR were taken at baseline, and data from the 1-year follow-up, including the modified Rankin Scale (mRS) and survival status, was obtained for all patients. Patients included in the study were classified into four groups according to NLR quartiles (Q1-Q4). Logistic regression was used to analyze the relationship between different NLR levels and poor outcomes (mRS 3– 5 and mRS 3– 6).Results: A total of 594 ICH patients were enrolled. Glasgow Coma Scale (GCS), NIH Stroke Scale (NIHSS) and hematoma volume at first admission were significantly different between different NLR level groups (all P values < 0.05). In the multivariate logistic regression model, at the 30-day follow-up, the Q4 (significantly increased NLR) group showed an elevated risk of poor outcomes (OR, 2.37; 95% CI, 1.17– 4.83, P=0.02) and functional disability (OR, 2.21; 95% CI, 1.05– 4.65, P=0.04). At the 3-month follow-up, the Q4 group still showed an elevated risk of poor outcomes (OR, 2.83; 95% CI, 1.38– 5.77, P< 0.01) and functional disability (OR, 2.77; 95% CI, 1.28– 5.98, P< 0.01). At the 1-year follow-up, the Q2 (slightly elevated NLR) group showed significant functional disability (OR, 0.34; 95% CI, 0.16– 0.72, P< 0.01).Conclusion: A significantly increased NLR may have an impact on the poor outcomes and functional disability of patients with ICH, while a slightly elevated NLR may play a protective role.Keywords: neutrophil-to-lymphocyte ratio, functional outcome, spontaneous intracerebral hemorrhage

Keywords

• neutrophil-to-lymphocyte ratio
• functional outcome
• spontaneous intracerebral hemorrhage