Tao Chuanyuan, Wang Jiajing, Hu Xin, Ma Junpeng, Li Hao, You Chao
Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Department of Critical Care Medicine, Neurosurgical Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Neurocrit Care. 2017 Jun;26(3):393-401. doi: 10.1007/s12028-016-0332-0.
Inflammation and thrombosis are associated with the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are emerging as novel inflammatory markers in stroke. We aimed to identify the association of NLR and PLR with delayed cerebral ischemia (DCI) and 3-month outcome after aSAH.
Two hundred and forty-seven patients diagnosed with aSAH within 24 h of symptoms onset were enrolled. Clinical, neuroradiological, laboratory, and follow-up data were collected from electronic database. Functional outcome was assessed by modified Rankin Scale. Admission NLR, PLR, and combined NLR-PLR associated with outcomes were evaluated by logistic regression analysis, and we used receiver operating characteristic curves to detect the overall predictive accuracy of these markers.
Fifty-five (22.3 %) patients had unfavorable outcome and 47 (19 %) developed DCI. Both NLR and PLR were correlated with WFNS grade (ρ = 0.35[p < 0.001], ρ = 0.28[p < 0.001]) and modified Fisher grade (ρ = 0.25[p = 0.001], ρ = 0.28[p = 0.003]) and independently related to DCI (OR 2.18, 95 %CI 1.51-3.15, p = 0.016; OR 2.21, 95 %CI 1.61-3.32, p = 0.008) and functional outcome (OR 1.89, 95 %CI 1.52-3.17, p = 0.015; OR 1.77, 95 %CI 1.48-3.21, p = 0.018) at 3 months after aneurysm repair. They had comparable predictive ability in DCI occurrence (area under the curve [AUC] 0.65, 95 %CI 0.55-0.74, p = 0.002; AUC 0.68, 95 %CI 0.60-0.76, p < 0.001) and poor outcome (AUC 0.70, 95 %CI 0.63-0.77, p < 0.001; AUC 0.65, 95 %CI 0.58-0.72, p = 0.001). However, combination of the two indexes showed a better predictive value than each alone (AUC 0.73, 95 %CI 0.66-0.81, p < 0.001 for DCI; AUC 0.76, 95 %CI 0.70-0.83, p < 0.001 for poor outcome).
NLR and PLR as novel inflammatory biomarkers are independent predictors of DCI development and functional outcome after acute aSAH. When combined together, they may help to identify high-risk patients more powerfully.
炎症和血栓形成与动脉瘤性蛛网膜下腔出血（aSAH）的发病机制相关，中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）正逐渐成为卒中的新型炎症标志物。我们旨在确定NLR和PLR与aSAH后迟发性脑缺血（DCI）及3个月预后的关联。
纳入247例在症状发作后24小时内确诊为aSAH的患者。从电子数据库收集临床、神经放射学、实验室及随访数据。采用改良Rankin量表评估功能预后。通过逻辑回归分析评估入院时NLR、PLR及联合NLR-PLR与预后的相关性，并使用受试者工作特征曲线检测这些标志物的总体预测准确性。
55例（22.3%）患者预后不良，47例（19%）发生DCI。NLR和PLR均与世界神经外科医师联盟（WFNS）分级（ρ = 0.35[p < 0.001]，ρ = 0.28[p < 0.001]）及改良Fisher分级（ρ = 0.25[p = 0.001]，ρ = 0.28[p = 0.003]）相关，且独立与动脉瘤修复术后3个月的DCI（比值比[OR]2.18，95%置信区间[CI]1.51 - 3.15，p = 0.016；OR 2.21，95%CI 1.61 - 3.32，p = 0.008）及功能预后（OR 1.89，95%CI 1.52 - 3.17，p = 0.015；OR 1.77，95%CI 1.48 - 3.21，p = 0.018）相关。它们在预测DCI发生方面具有相当的能力（曲线下面积[AUC]0.65，95%CI 0.55 - 0.74，p = 0.002；AUC 0.68，95%CI 0.60 - 0.76，p < 0.001）及不良预后（AUC 0.7日，95%CI 0.63 - 0.77，p < 0.001；AUC 0.65，95%CI 0.58 - 0.72，p = 0.001）。然而，两项指标联合显示出比单独一项更好的预测价值（DCI的AUC为0.73，95%CI 0.66 - 0.81，p < 0.001；不良预后的AUC为0.76，95%CI 0.70 - 0.83，p < 0.001）。
NLR和PLR作为新型炎症生物标志物是急性aSAH后DCI发生及功能预后的独立预测指标。两者联合使用可能更有力地帮助识别高危患者。
