A High Immediate Postoperative Neutrophil-to-Albumin Ratio is Associated With Unfavorable Clinical Outcomes at Hospital Discharge in Patients With Aneurysmal Subarachnoid Hemorrhage

Abstract

Background: Inflammation is associated with unfavorable clinical outcomes after aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the relationship between postoperative neutrophil-to-albumin ratio (NAR) and unfavorable clinical outcomes (modified Rankin score ≥ 3) at hospital discharge in aSAH patients. Methods: Five hundred sixty aSAH patients undergoing surgical or endovascular treatment were included in this retrospective study. Patients were initially allocated to high (n = 247) or low (n = 313) postoperative NAR groups based on the immediate postoperative NAR cutoff value identified by receiver operating characteristic analysis, and then further subclassified into 4 groups: HH (high pre-and high postoperative NAR, n = 156), LH (low preoperative and high postoperative NAR, n = 91), HL (high preoperative and low postoperative NAR, n = 68), and low pre-and low postoperative NAR (n = 245).Results: Optimum cutoff values of immediate postoperative and preoperative NAR were 2.45 and 2.09, respectively. Unfavorable clinical outcomes were more frequent in patients with high compared with low postoperative NAR (45.3% vs. 13.4%; P < 0.001). In multivariate analysis, postoperative NAR was a significant predictor of unfavorable clinical outcomes (odds ratio, 2.10; 95% CI, 1.42-3.10; P < 0.001). Unfavorable clinical outcomes were less frequent in group low pre-and low postoperative NAR than in groups HH, LH, and HL (9.4% vs. 44.9%, 46.2% and 27.9%, respectively; all P < 0.001) and also in Group HL compared with groups HH and LH (P = 0.026 and P = 0.030); clinical outcomes did not differ between Groups HH and LH.Conclusions: A high immediate postoperative NAR was associated with unfavorable clinical outcomes at hospital discharge in aSAH patients.