Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India; Institute of Neurological Sciences, Glasgow, United Kingdom.
Clin Neurol Neurosurg. 2021 Jan;200:106339. doi: 10.1016/j.clineuro.2020.106339. Epub 2020 Oct 28.
Inflammation plays a role in secondary brain injury after intracerebral haemorrhage (ICH). Peripheral biomarkers of inflammation especially the neutrophil-to-lymphocyte ratio (NLR) have been shown to influence outcome following ischemic stroke and traumatic brain injury. Role of NLR in outcome prognostication following haemorrhagic stroke has not yet been conclusively established. This study analyses the prognostic significance of admission neutrophil to lymphocyte ratio on mortality and 90-day outcome in patients admitted with acute SICH.
A total of 851 patients with spontaneous ICH were retrospectively investigated. Admission haematological parameters were retrieved from our hospital laboratory systems and NLR was then calculated using the formula ANC/ALC. (Absolute neutrophil count/Absolute lymphocyte count) Clinical outcome was assessed by modified Rankin Scale at 90 days. Logistic regression was performed to identify independent risk factors of mortality and 90-day outcome. Receiver operator curve (ROC) test was used to determine the predictive value of NLR for 30-day death.
A total of 851 patients enrolled in the study. Our 30 day and 90 day mortality were 125 (17.7 %) and 244 (28.7 %) respectively. The mean NLR in the entire cohort was 9.03 ± 7.6. NLR was significantly higher in the mortality group compared to the survivors (11.98 ± 9.91 vs 8.52 ± 7.05) P < 0.001. NLR in patients with a good outcome at 90 days (7.21 ± 6.06) was a lower in comparison to patients with poor outcome(10.66 ± 8.48).(p=<0.001). NLR was dichotomised at 8.2 which was computed based on ROC curve. Mortality and poor outcome were higher in the NLR > 8.2 group at 140 (40.1 %) and 23 (67.8 %) respectively (p < 0.001). Age, GCS < 8, Volume of Hematoma, Intra ventricular extension of hematoma and NLR > 8.2 were found to be independent predictors of outcome. GCS < 8 had a greater predictive value (5.236) compared to NLR.8.2 (1.78).
Elevated levels of admission NLR were independently related to poor mortality and 90-day outcome after ICH. NLR is a novel, easily available and cost effective prognostic biomarker following ICH.
炎症在脑出血（ICH）后的继发性脑损伤中起作用。外周炎症生物标志物，尤其是中性粒细胞与淋巴细胞比值（NLR），已被证明会影响缺血性卒中和创伤性脑损伤的预后。NLR 在出血性卒中预后中的作用尚未得到明确证实。本研究分析了入院时 NLR 对急性 SICH 患者死亡率和 90 天结局的预后意义。
回顾性分析了 851 例自发性 ICH 患者。从我院实验室系统中检索入院时的血液学参数，并使用公式 ANC/ALC（绝对中性粒细胞计数/绝对淋巴细胞计数）计算 NLR。（中性粒细胞计数/淋巴细胞计数）90 天时采用改良 Rankin 量表评估临床结局。采用 logistic 回归分析确定死亡率和 90 天结局的独立危险因素。接受者操作特征曲线（ROC）试验用于确定 NLR 对 30 天死亡的预测价值。
共纳入 851 例患者。我们的 30 天和 90 天死亡率分别为 125（17.7%）和 244（28.7%）。整个队列的平均 NLR 为 9.03±7.6。死亡组的 NLR 明显高于存活组（11.98±9.91 与 8.52±7.05），P<0.001。90 天预后良好的患者的 NLR（7.21±6.06）明显低于预后不良的患者（10.66±8.48）（p<0.001）。NLR 根据 ROC 曲线计算为 8.2，NLR 分为 8.2。在 NLR>8.2 组，死亡率和预后不良发生率分别为 140（40.1%）和 23（67.8%），均较高（p<0.001）。年龄、GCS<8、血肿量、脑室内血肿延伸和 NLR>8.2 是预后的独立预测因子。GCS<8 的预测价值（5.236）大于 NLR.8.2（1.78）。
入院时 NLR 升高与 ICH 后死亡率和 90 天预后不良独立相关。NLR 是 ICH 后一种新的、易于获得且具有成本效益的预后生物标志物。
