中性粒细胞与淋巴细胞比值预测动脉瘤性蛛网膜下腔出血预后不良：一项回顾性研究和更新的荟萃分析。
Neutrophil to lymphocyte ratio predicting poor outcome after aneurysmal subarachnoid hemorrhage: A retrospective study and updated meta-analysis.
机构信息
Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China.
出版信息
Front Immunol. 2022 Aug 9;13:962760. doi: 10.3389/fimmu.2022.962760. eCollection 2022.
BACKGROUND
The relationship between neutrophil to lymphocyte ratio (NLR) and poor outcome of aneurysmal subarachnoid hemorrhage (aSAH) is controversial. We aim to evaluate the relationship between NLR on admission and the poor outcome after aSAH.
METHOD
Part I: Retrospective analysis of aSAH patients in our center. Baseline characteristics of patients were collected and compared. Multivariate analysis was used to evaluate parameters independently related to poor outcome. Receiver operating characteristic (ROC) curve analysis was used to determine the best cut-off value of NLR. Part II: Systematic review and meta-analysis of relevant literature. Related literature was selected through the database. The pooled odds ratio (OR) and corresponding 95% confidence interval (CI) were calculated to evaluate the correlation between NLR and outcome measures.
RESULTS
Part I:A total of 240 patients with aSAH were enrolled, and 52 patients had a poor outcome. Patients with poor outcome at 3 months had a higher admission NLR, Hunt & Hess score, Barrow Neurological Institute (BNI) scale score, Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), and proportion of hypertension history. After adjustment, NLR at admission remained an independent predictor of poor outcome in aSAH patients (OR 0.76, 95% CI 0.69-0.83; P < 0.001). The best cut-off value of NLR in ROC analysis is 12.03 (area under the curve 0.805, 95% CI 0.735 - 0.875; < 0.001). Part II: A total of 16 literature were included. Pooled results showed that elevated NLR was significantly associated with poor outcome (OR 1.31, 95% CI 1.14-1.49; < 0.0001) and delayed cerebral ischemia (DCI) occurrence (OR 1.32, 95% CI 1.11-1.56; = 0.002). The results are more reliable in large sample sizes, low NLR cut-off value, multicenter, or prospective studies.
CONCLUSION
Elevated NLR is an independent predictor of poor outcome and DCI occurrence in aSAH.
背景
中性粒细胞与淋巴细胞比值（NLR）与动脉瘤性蛛网膜下腔出血（aSAH）不良预后的关系存在争议。本研究旨在评估入院时 NLR 与 aSAH 不良预后之间的关系。
方法
第一部分：对我院 aSAH 患者进行回顾性分析。收集患者的基线特征并进行比较。采用多变量分析评估与不良预后相关的独立参数。采用受试者工作特征（ROC）曲线分析确定 NLR 的最佳截断值。第二部分：对相关文献进行系统评价和荟萃分析。通过数据库检索相关文献。计算合并优势比（OR）及其相应的 95%置信区间（CI），以评估 NLR 与结局指标之间的相关性。
结果
第一部分：共纳入 240 例 aSAH 患者，其中 52 例预后不良。3 个月预后不良的患者入院时 NLR、Hunt & Hess 评分、巴罗神经研究所（BNI）评分、蛛网膜下腔出血早期脑肿胀评分（SEBES）和高血压病史比例更高。校正后，入院时 NLR 仍然是 aSAH 患者不良预后的独立预测因素（OR 0.76，95%CI 0.69-0.83；P<0.001）。ROC 分析中 NLR 的最佳截断值为 12.03（曲线下面积 0.805，95%CI 0.735-0.875；P<0.001）。第二部分：共纳入 16 项文献。汇总结果显示，升高的 NLR 与不良预后（OR 1.31，95%CI 1.14-1.49；P<0.0001）和迟发性脑缺血（DCI）发生（OR 1.32，95%CI 1.11-1.56；P=0.002）显著相关。在大样本量、低 NLR 截断值、多中心或前瞻性研究中，结果更为可靠。
结论
入院时 NLR 升高是 aSAH 不良预后和 DCI 发生的独立预测因素。
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