Admission Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratio as a predictor of mortality in patients with Subarachnoid Hemorrhage

Abstract

INTRODUCTION: Inflammation is associated with the pathogenesis of subarachnoid hemorrhage (SAH) which is a serious disease with high mortality. NLR and PLR as novel inflammatory markers may serve as predictors of clinical severity and mortality in patients with SAH. METHODS: Medical records of adult SAH patients who were admitted to our Neurology and Neurosurgery Departments were investigated. Clinical, neuroradiological, laboratory, and follow-up data were collected from electronic database. Admission complete blood count values including hemoglobin, leukocyte, neutrophil, platelet and mean platelet volume, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were also studied. Fisher score and mortality rates were also evaluated. RESULTS: A total of 152 patients with a mean age of 52.94±17.04 (20-104) years, (94 (%61.8) females and 58 (38.2%) males) with SAH were included in the study. The patients were divided into two groups: aneurysmal (group 1, n:99) and nonaneurysmal SAH (group 2, n:53). In comparison of complete blood count parameters we found lower lymphocyte and higher neutrophil, NLR and PLR values in aneurysmal SAH patients who had also higher Fisher scores and mortality rate. There were also correlations between Fisher score and leukocyte, neutrophil, lymphocyte, NLR and PLR values. We also found that advanced age and higher NLR, PLR values are significantly related to mortality rates independent of presence of aneurysm. DISCUSSION and CONCLUSION: Aneurysmal SAH patients had lower lymphocyte and higher neutrophil, NLR, PLR values with higher mortality rates and disease severity. Additionally advanced age and higher NLR, PLR values were significantly related to mortality rates independent of presence of aneurysm. We believe that NLR and PLR can be used as simple parameters to evaluate severity of SAH and short term mortality in clinical practice.

The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage

“…In this study, the effects of the absolute neutrophil count and absolute lymphocyte count on mortality were compared separately, and the results showed that there was no difference ( 72 ). Yilmaz et al also found that the NLR was associated with the Fisher score and mortality and was a simple indicator of aSAH patient severity and short-term mortality ( 79 ).…”

“…An NLR <3.62 was 81.3% sensitive and 83.3% specific in discriminating traumatic SAH patients from aneurysmal SAH patients, indicating that this hemorrhage might be traumatic Yilmaz et al(79) Higher NLR values were significantly related to mortality rates.Huang et al (80)NLRs were significantly associated with hospital death, and higher 1 year mortalityTao et al (81) NLR is independently related to DCI and functional outcome at 3 months after aneurysm repair. The combination of NLR and PLR showed a better predictive value than each alone for DCI and poor outcome Zhang et al (82) NLR was a useful and potential tool in distinguishing between SAH and non-traumatic acute headache.…”