Abstract
In a previous study in patients with intracranial hemorrhage (ICH), we found an association between high neutrophil-to-lymphocyte ratio (NLR) with poor short-term mortality. In the current study, this preliminary finding was validated using an independent patient cohort. A total of 181 ICH patients (from January 2016 to December 2017) were included. Diagnosis was confirmed using computed tomography (CT) in all cases. Patient survival (up to 30 days) was compared between subjects with high NLR (above the 7.35 cutoff; n = 74) versus low NLR (≤ 7.35; n = 107) using Kaplan-Meier analysis. A multivariate logistic regression was performed to identify factors that influenced the 30-day mortality. Correlation between NLR with other relevant factors (e.g., C-reactive protein (CRP) and fibrinogen) was examined using Spearman correlation analysis. The 30-day mortality was 19.3% (35/181) in the entire sample, 37.8% (28/74) in the high-NLR group, and 6.5% (7/107) in the low-NLR group (P < 0.001). In comparison to the low-NLR group, the high-NLR group had higher rate of intraventricular hemorrhage (29.7 vs. 16.8%), ICH volume (median 23.9 vs. 6.0 cm3) and ICH score (median 1.5 vs. 0), and lower GCS score (9.4 ± 4.5 vs. 12.9 ± 3.2). An analysis that divided the samples into three equal parts based on NLR also showed increasing 30-day mortality with incremental NLR (1.6, 15.0, and 41.7% from lowest to highest NLR tertile, P for trend < 0.001). Kaplan-Meier curve showed higher 30-day mortality in subjects with high NLR than those with low NLR (P < 0.001 vs. low-NLR group, log-rank test). High NLR (> 7.35) is associated with poor short-term survival in acute ICH patients.
Highlights
Acute intracerebral hemorrhage (ICH) is associated with high disability and mortality
High neutrophil-tolymphocyte ratio (NLR) is associated with 30-day mortality (Wang et al 2016) and in-hospital mortality (Giede-Jeppe et al 2017), as well as 90-day mortality (Lattanzi et al 2016a, b; Tao et al 2017) in ICH patients
In patients with ischemic stroke, high NLR has been associated with hemorrhagic transformation upon thrombolysis (Guo et al 2016)
Summary
Acute intracerebral hemorrhage (ICH) is associated with high disability and mortality. Activated inflammatory cells could release a variety of proinflammatory cytokines and proteases (Zhao et al 2007), which in turn cause secondary brain injury. Typically the result of inflammatory responses and mechanical compression by hematoma, is a major clinical feature of secondary brain injury and contributes to neurological deterioration (Babu et al 2012). A recent study from this research group (Wang et al 2016) showed an association of high NLR with 30-day mortality in ICH patients. High NLR has been suggested to be predictive for 90-day prognosis (Lattanzi et al 2016b and early neurological deterioration in patients with acute ICH (Lattanzi et al 2017b). We used an independent cohort of ICH patients to validate our previous finding that high NLR (> 7.35) is associated with 30-day mortality in ICH patients
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