Prognostic role of neutrophil-to-lymphocyte ratio in patients with brain arteriovenous malformations

Sunfu Zhang,Jing Zhang,Qingqing Ren,Jianguo Xu,Baoyin Shan,Min He,Zhiyong Liu,Yunhui Zeng,Hao Liu

doi:10.18632/oncotarget.24236

Abstract

// Sunfu Zhang 1, * , Jing Zhang 1, * , Qingqing Ren 1, * , Min He 1, * , Baoyin Shan 1 , Yunhui Zeng 1 , Zhiyong Liu 1 , Hao Liu 1 and Jianguo Xu 1 1 Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, The First People’s Hospital of Yibin, Sichuan, People’s Republic of China * These authors contributed equally to this work Correspondence to: Jianguo Xu, email: jgx_2015@163.com Keywords: brain arteriovenous malformations; cerebral hemorrhage; neutrophils; lymphocytes; prognosis. Received: March 10, 2017      Accepted: December 05, 2017      Published: January 02, 2018 ABSTRACT Purpose: This study was to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with brain arteriovenous malformations (AVMs). Materials and Methods: Patients with AVMs were retrospectively identified. A hemogram from peripheral venous blood samples was taken within 24 hours of admission. The occurrences of death or major disability were noted at the end point of 6 months and the outcome was assessed with a modified Rankin Scale score. Results: A total of 175 patients were enrolled. There were 97 (55%) patients in the ruptured AVMs group and 78 (45%) in the unruptured AVMs group. In patients with unruptured AVMs, NLR was an independent risk factor for poor outcome at 6 months ( p = .036), but not a significant predictor with a ROC area of 0.638. Whereas, NLR was higher in the patients with poor outcome in ruptured AVMs group ( p < .001). The area under the curve was .864 ( P < .001), and an NLR of 8.88 was identified the best discriminating variable and the best predictive cutoff value. Conclusions: NLR represented a reliable prognostic predictor for patients with ruptured AVMs. However, the NLR could not be a useful prognostic predictor for patients presented with unruptured AVMs.

Highlights

Arteriovenous malformations (AVMs) are the most common type of intracranial vascular malformations, and the leading cause of non-traumatic intracerebral hemorrhages in young people less than 35 years old [1]
neutrophil-tolymphocyte ratio (NLR) was higher in the patients with poor outcome in ruptured arteriovenous malformations (AVMs) group (p < .001)
The NLR could not be a useful prognostic predictor for patients presented with unruptured AVMs

Summary

Introduction

Arteriovenous malformations (AVMs) are the most common type of intracranial vascular malformations, and the leading cause of non-traumatic intracerebral hemorrhages in young people less than 35 years old [1]. The mechanisms involved in the growth, progression, and rupture of AVMs are not clearly understood, but studies have shown that inflammation makes a great contribution to their pathogenesis [9]. Cytokines and proinflammatory factors are secreted followed by inflammatory responses, resulting in increased angiogenesis and various proteinases, which leads to the breakdown of extracellular matrix and cell death, all of which contribute to AVM wall weakening and rupture [11]. Arteriovenous malformation rupture makes intracerebral hemorrhage (ICH) the major cause of AVM-related morbidity and mortality. The inflammatory response contributes to the ICH-induced secondary brain injury the mechanisms are unknown [12]

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