Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor of 30-Day Mortality of Intracerebral Hemorrhage Patients: a Validation Cohort Study

Abstract

In a previous study in patients with intracranial hemorrhage (ICH), we found an association between high neutrophil-to-lymphocyte ratio (NLR) with poor short-term mortality. In the current study, this preliminary finding was validated using an independent patient cohort. A total of 181 ICH patients (from January 2016 to December 2017) were included. Diagnosis was confirmed using computed tomography (CT) in all cases. Patient survival (up to 30 days) was compared between subjects with high NLR (above the 7.35 cutoff; n = 74) versus low NLR (≤ 7.35; n = 107) using Kaplan-Meier analysis. A multivariate logistic regression was performed to identify factors that influenced the 30-day mortality. Correlation between NLR with other relevant factors (e.g., C-reactive protein (CRP) and fibrinogen) was examined using Spearman correlation analysis. The 30-day mortality was 19.3% (35/181) in the entire sample, 37.8% (28/74) in the high-NLR group, and 6.5% (7/107) in the low-NLR group (P < 0.001). In comparison to the low-NLR group, the high-NLR group had higher rate of intraventricular hemorrhage (29.7 vs. 16.8%), ICH volume (median 23.9 vs. 6.0 cm3) and ICH score (median 1.5 vs. 0), and lower GCS score (9.4 ± 4.5 vs. 12.9 ± 3.2). An analysis that divided the samples into three equal parts based on NLR also showed increasing 30-day mortality with incremental NLR (1.6, 15.0, and 41.7% from lowest to highest NLR tertile, P for trend < 0.001). Kaplan-Meier curve showed higher 30-day mortality in subjects with high NLR than those with low NLR (P < 0.001 vs. low-NLR group, log-rank test). High NLR (> 7.35) is associated with poor short-term survival in acute ICH patients.

Excessive antibiotics use increased in-hospital mortality in intracerebral hemorrhage patients with stroke-associated infection

“…In the present study, we found NLR to be associated with poor short-term survival, confirming previous results from our research group [23][24][25] . We found that NIHSS score was an independent risk factor of death, and that it correlated positively with PAUD.…”

Circulating Neutrophil-to-Lymphocyte Ratio at Admission Predicts the Long-Term Outcome in Acute Traumatic Cervical Spinal Cord Injury Patients

“…A high NLR at admission was reported to be an indicator of poor outcome in ICH patients, though the mechanism remained unclear. [11] In the current study, cervical tSCI patients who had a higher NLR were more likely to have a poor outcome measured by AIS grade, which is consistent with results from ICH or TBI patients. Moreover, the level of NLR is similar with that in TBI patients, and much higher than the level in ICH patients.…”

“…Favorable prognostic value of circulating NLR at admission had been reported in ICH and TBI patients. [11,18] It is expected that the prognostic value of NLR would be favorable in predicting the outcome of patients with cervical tSCI which shares the similar secondary injury mechanism as TBI. Univariate analysis showed signi cant correlation between NLR and patient outcome, the prognostic effect remained substantial following adjusted analysis, suggesting NLR is of considerable prognostic relevance in cervical tSCI patients.…”

“…[9] It was reported that high neutrophils and low lymphocytes level in the peripheral blood at admission were independently associated with poor outcome of intracerebral hemorrhage (ICH) patients, and the neutrophil-to-lymphocyte ratio (NLR) was readily available as an outcome predictor. [10,11] Nevertheless, the prognostic value of NLR for the outcome of tSCI patients has rarely been studied.…”

Circulating neutrophil-to-lymphocyte ratio at admission predicts the long-term outcome in acute traumatic cervical spinal cord injury patients

“…After focal tSCI, circulating neutrophils can be observed to be recruited to the site of injury within 1 h, which is considered as an indicator of acute inflammation [9]. It was reported that high neutrophils and low lymphocytes level in the peripheral blood at admission were independently associated with poor outcome of intracerebral hemorrhage (ICH) patients, and the neutrophil-to-lymphocyte ratio (NLR) was readily available as an outcome predictor [10,11]. Nevertheless, the prognostic value of NLR for the outcome of tSCI patients has rarely been studied.…”