Neutrophil to lymphocyte ratio predicts the outcomes in patients with acute intracerebral hemorrhage

Abstract

Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) in peripheral blood for the outcomes in patients with acute intracerebral hemorrhage. Methods Consecutive inpatients with intracerebral hemorrhage diagnosed with the head CT were enrolled. The modified Rankin Scale (mRS) was used to evaluate the functional outcomes at 90 d, 0-2 was defined as good outcome, 3-6 were defined as poor outcome, and 6 was defined as death. Univariate analysis was used to compare the demographic characteristics, baseline data, imaging, and laboratory findings between the groups. Multivariate logistic regression analysis was used to determine the independent correlation between NLR and the outcomes, and receiver operating characteristics (ROC) analysis was performed to assess the predictive value of NLR for the outcomes. Results A total of 205 patients with acute intracerebral hemorrhage were enrolled in the study, 107 (52.2%) had poor outcome and 57 (27.8%) died. There were significant differences in age (P=0.038), Glasgow Coma Scale (GCS) scores (P=0.001), National Institutes of Health Stroke Scale (NIHSS) scores (P=0.001), neutrophil count (P=0.005), lymphocyte count (P=0.002), NLR (P=0.001), fasting blood glucose (P=0.012), hypersensitivity C-reactive protein (P=0.002), hematoma volume (P=0.005), and proportion of bleeding into the ventricles (P=0.002) between the poor outcome group and the good outcome group. There were significant differences in age (P=0.002), previous stroke (P=0.018), GCS scores (P=0.001), NIHSS scores (P=0.001), neutrophil count (P=0.008), lymphocyte count (P=0.001), NLR (P=0.001), fasting blood glucose (P=0.016), hematoma volume (P=0.001), and proportion of bleeding into ventricle (P=0.002) between the death group and the survival group. Multivariate logistic regression analysis showed that NLR was an independent predictive factor for poor outcome (odds ratio [OR] 2.405, 95% confidence interval [CI] 1.613-3.587; P=0.001) and death (OR 2.268, 95% CI 1.532-3.358; P=0.001) after adjusting for confounders. The ROC curve analysis showed that NLR had a higher predictive value for poor outcome at 90 d (area under the ROC curve 0.703, 95% CI 0.632-0.774; P<0.001). When the cutoff value was 2.3, the sensitivity and specificity were 61.7% and 72.4%, respectively. NLR also had a predictive value for death within 90 d (area under the ROC curve 0.706, 95% CI 0.629-0.786; P=0.003). When the cutoff value was 2.2, the sensitivity and specificity were 63.2% and 72.6%, respectively. Conclusion NLR may have certain predict value for outcomes in patients with acute intracerebral hemorrhage. Key words: Cerebral Hemorrhage; Leukocyte Count; Neutrophils; Lymphocytes; Prognosis