The Trends of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Systemic Immunoinflammatory Index in Patients with Intracerebral Hemorrhage and Clinical Value in Predicting Pneumonia 30 Days After Surgery

Abstract

BackgroundInflammatory response is closely associated with secondary brain injury and pneumonia in intracerebral hemorrhage (ICH). In this study, we aimed to investigate the value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immunoinflammatory index (SII) in the development of pneumonia in ICH patients 30 days after surgery. MethodsWe retrospectively collected clinical data on patients with ICH who underwent surgical treatment at our institution from January 2016 to December 2022, mainly including NLR, PLR and SII at different time points. Receiver operating characteristic (ROC) curves were used to compare the value of different inflammatory indicators in predicting the development of postoperative pneumonia 30 days after surgery in ICH patients, and multivariate logistic regression analyses were used to identify independent risk factors for pneumonia 30 days after surgery. ResultsAmong 112 patients with intracerebral hemorrhage undergoing surgical treatment, 31 (27.7%) developed pneumonia postoperatively. The results of the univariate analysis demonstrated that patients in the pneumonia group experienced significantly higher blood glucose, NLR3, PLR3, and SII3 than those in the non- pneumonia group, and significantly lower admission Glasgow Coma Scale (GCS) scores than those in the Non- pneumonia group (all P<0.05). NLR, PLR, and SII showed an increasing and then decreasing in the disease process of intracerebral hemorrhage, and peaked at 48 hours postoperatively. Multivariable logistic regression analysis revealed that SII3 was an independent risk factor for postoperative pneumonia 30 days after surgery in ICH patients (OR=1.001, 95%CI: 1.000-1.002, P=0.008). The area under the curve (AUC) of the developed nomogram model was 0.895 (95%CI = 0.823 - 0.967), with a sensitivity and specificity of 0.903 and 0.815, respectively, providing good predictive power. ConclusionsIn the course of intracerebral hemorrhage, NLR, PLR, and SII increased and then decreased, and peaked at 48 hours postoperatively. The SII3 was the best predictor of the occurrence of pneumonia postoperatively in ICH patients.