Abstract
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 24h 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 3months 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.
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