Abstract
Immunity plays key roles in pathophysiology of intracerebral hemorrhage (ICH). The aim of the study was to determine whether the peripheral leukocyte count and neutrophil-to-lymphocyte ratio (NLR) predicted neurological deterioration (ND) after ICH. We identified consecutive patients with ICH who had blood sampling performed within 24 hours from symptom's onset. Total white blood cells (WBC), absolute neutrophil count (ANC) and absolute lymphocyte count (ALC) were retrieved, and the NLR computed as the ratio of the ANC to ALC values. The study endpoint was the occurrence of neurological deterioration (ND) within 7 days after ICH. One hundred ninety-two subjects were enrolled, whose 54 (28.1%) presented ND. At multivariate analysis, the WBC (adjusted odd ratio [adjOR] for 1,000 leukocytes increase 1.29, 95% confidence interval [CI] 1.11-1.50), ANC (adjOR for 1,000 neutrophils increase 1.61, 95% CI 1.30-1.99), ALC (adjOR for 1,000 lymphocytes increase 0.21, 95% CI 0.09-0.49) and NLR (adjOR for 1-point increase 1.65, 95% CI 1.36-2.00) were independently associated with ND (p≤0.001). The NLR resulted the best discriminating variable for the occurrence of the adverse outcome (area under the curve 0.888, 95% CI 0.832-0.945; p < 0.001). The NLR predicted ND after acute ICH and can aid in the risk stratification of patients.
Highlights
Spontaneous intracerebral haemorrhage (ICH) represents approximately 10% to 15% of all strokes and affects over 1 million people per year worldwide
Neurological deterioration (ND) is common after ICH and it is associated with increased length of in-hospital stay, poor functional recovery and death [2]; notwithstanding, reliable and easy-to-use predictors allowing the early identification of unstable at-risk patients are not well established
Immune reaction is a major feature of ICH pathology and influences its course; the response to cerebral hematoma is not bounded to the brain and results in systemic effects, and inflammatory markers on admission, such as fever, elevated leukocyte count, interleukin-6 and C-reactive protein are associated with worse prognosis [3,4,5]
Summary
Spontaneous intracerebral haemorrhage (ICH) represents approximately 10% to 15% of all strokes and affects over 1 million people per year worldwide. It is characterized by high rates of mortality and residual disability among survivors, and currently no therapeutic strategies have demonstrated definitive benefit [1]. The neutrophil-to-lymphocyte ratio (NLR), an available synthesis of the inflammatory levels and enhanced immune pathways, is associated to 3-month recovery in ICH patients [6, 7], but its link with short term outcome is unknown. The aim of this study was to evaluate the relationship between the total and differential leukocyte counts and the NLR at admission with the occurrence of ND during the initial week after ICH onset
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