Neutrophil to Lymphocyte Ratio and Serum Biomarkers : A Potential Tool for Prediction of Clinically Relevant Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Abstract

Objective : Subarachnoid hemorrhage (SAH) is a condition characterized by bleeding in the subarachnoid space, often resulting from the rupture of a cerebral aneurysm. Delayed cerebral ischemia caused by vasospasm is a significant cause of mortality and morbidity in SAH patients, and inflammatory markers such as systemic inflammatory response index (SIRI), systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), and derived NLR (dNLR) have shown potential in predicting clinical vasospasm and outcomes in SAH patients. This article aims to investigate the relationship between inflammatory markers and cerebral vasospasm after aneurysmatic SAH (aSAH) and evaluate the predictive value of various indices, including SIRI, SII, NLR, and dNLR, in predicting clinical vasospasm.Methods : A retrospective analysis was performed on a cohort of 96 patients who met the inclusion criteria out of a total of 139 patients admitted Trakya University Hospital with a confirmed diagnosis of aSAH between January 2013 and December 2021. Diagnostic procedures, neurological examinations, and laboratory tests were performed to assess the patients' condition. The Student’s t-test compared age variables, while the chi-square test compared categorical variables between the non-vasospasm (NVS) and vasospasm (VS) groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic accuracy of laboratory parameters, calculating the area under the ROC curve, cut-off values, sensitivity, and specificity. A significance level of p<0.05 was considered statistically significant.Results : The study included 96 patients divided into two groups : NVS and VS. Various laboratory parameters, such as NLR, SII, and dNLR, were measured daily for 15 days, and statistically significant differences were found in NLR on 7 days, with specific cut-off values identified for each day. SII showed a significant difference on day 9, while dNLR had significant differences on days 2, 4, and 9. Graphs depicting the values of these markers for each day are provided.Conclusion : Neuroinflammatory biomarkers, when used alongside radiology and scoring scales, can aid in predicting prognosis, determining severity and treatment decisions for aSAH, and further studies with larger patient groups are needed to gain more insights.

Advances in biomarkers for vasospasm – Towards a future blood-based diagnostic test

“…Specifically, NLR showed a significant difference on the seventh day, dNLR on days 2, 4, and 9, and SII on day 9. 75 A different study using SII found similar results in which the SII analysis predicted vasospasm accurately (area under the curve = 0.767 & p < 0.001). 76 General leukocytosis has also been found to be an independent risk factor for vasospasm following SAH.…”

Correlation of Inflammatory Parameters with the Development of Cerebral Vasospasm, Takotsubo Cardiomyopathy, and Functional Outcome after Spontaneous Subarachnoid Hemorrhage

“…Recently, in a retrospective study, Buce-Satoba et al demonstrated a relationship between white blood cell count and CRP values at admission and the development of VS [6]. Another retrospective study by Kula et al found significantly higher NLR in VS patients on days 6-10 and 12-13 after the insult [7]. In addition, several clinical studies have demonstrated associations between the appearance of DCI and higher values of inflammatory markers [25][26][27][28][29][30].…”

“…Although the underlying mechanism of cerebral vasospasm is still not fully explored, there is growing evidence that neuroinflammation has a significant role [4][5][6]. Among widely available laboratory markers, leukocyte count, neutrophil-to-lymphocyte ratio, and C-reactive protein levels showed correlations with variable complications and poor functional outcomes [6][7][8][9][10][11][12].…”