Neutrophil-to-lymphocyte ratio is associated with increased cerebral blood flow velocity in acute bacterial meningitis

Abstract

In community-acquired bacterial meningitis (CABM) intracranial vascular alterations are devastating complications which are triggered by neuroinflammation and result in worse clinical outcome. The Neutrophil-to-Lymphocyte ratio (NLR) represents a reliable parameter of the inflammatory response. In this study we analyzed the association between NLR and elevated cerebral blood flow velocity (CBFv) in CABM-patients. This study included all (CABM)-patients admitted to a German tertiary center between 2006 and 2016. Patients’ demographics, in-hospital measures, neuroradiological data and clinical outcome were retrieved from institutional databases. CBFv was assessed by transcranial doppler (TCD). Patients’, radiological and laboratory characteristics were compared between patients with/without elevated CBFv. Multivariate-analysis investigated parameters independently associated with elevated CBFv. Receiver operating characteristic(ROC-)curve analysis was undertaken to identify the best cut-off for NLR to discriminate between increased CBFv. 108 patients with CABM were identified. 27.8% (30/108) showed elevated CBFv. Patients with elevated CBFv and normal CBFv, respectively had a worse clinical status on admission (Glasgow Coma Scale: 12 [9–14] vs. 14 [11–15]; p = 0.005) and required more often intensive care (30/30 [100.0%] vs. 63/78 [80.8%]; p = 0.01).The causative pathogen was S. pneumoniae in 70%. Patients with elevated CBFv developed more often cerebrovascular complications with delayed cerebral ischemia (DCI) within hospital stay (p = 0.031). A significantly higher admission-NLR was observed in patients with elevated CBFv (median [IQR]: elevated CBFv:24.0 [20.4–30.2] vs. normal CBFv:13.5 [8.4–19.5]; p < 0.001). Multivariate analysis, revealed NLR to be significantly associated with increased CBFv (Odds ratio [95%CI] 1.042 [1.003–1.084]; p = 0.036). ROC-analysis identified a NLR of 20.9 as best cut-off value to discriminate between elevated CBFv (AUC = 0.713, p < 0.0001, Youden's Index = 0.441;elevated CBFv: NLR ≥ 20.9 19/30[63.5%] vs. normal CBFv: NLR > 20.9 15/78[19.2%]; p < 0.001). Intracranial vascular complications are common among CABM-patients and are a risk factor for unfavorable outcome at discharge. Elevated NLR is independently associated with high CBFv and may be useful in predicting patients’ prognosis.

Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury

“…The present study pooled IPD of five observational studies conducted at the university hospital Erlangen, a tertiary care centre in Germany. Patients with primary spontaneous intracerebral haemorrhage (ICH) from the prospective Univerisitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Haemorrhage study,20 21 patients with ischaemic stroke (IS) from a prospective stroke registry,22 patients with subarachnoid haemorrhage (SAH) from a prospective institutional SAH registry,23 patients with community-acquired bacterial meningitis (CABM) from a prospective institutional registry,24 and patients with status epilepticus (SE) from a retrospectively established institutional SE database25; admitted to the neurological intensive care unit (ICU) between 1 January 2012 and 31 December 2015 and ventilated ≥7 days were included. All studies were approved by the local institutional review board and patients or legal representatives provided informed consent unless waived by the review board 20 22–25…”

“…Data on demographics, clinical admission status and in-hospital parameters were assessed as previously published 20 22–27. Diagnosis of ICH, IS and SAH was established based on clinical findings and first cranial imaging scans after symptom onset 23 28.…”

“…Diagnosis of ICH, IS and SAH was established based on clinical findings and first cranial imaging scans after symptom onset 23 28. Diagnosis of CABM was confirmed by cerebrospinal fluid, laboratory and clinical findings 24 29. SE was defined as clinically or electroencephalographically persisting seizure ≥5 min or as a series of seizures without interictal recovery 25 30.…”

Neutrophil lymphocyte ratio as predictor of mortality in pediatric patients with bacterial meningitis: A retrospective cohort study

“…The NLR describes information from the innate and adaptive immune systems, and is a reliable parameter to describe the immune response to various stimuli/stressors. The NLR is calculated by dividing the absolute neutrophil count by the absolute lymphocyte count, and is an easy-to-use and efficient parameter [ 6 ].…”

“…From a previous study by Jeppe et al, in 2020, NLR affects the prognosis of patients with bacterial meningitis. Patients with high NLR have a high cerebral blood flow velocity which are associated with a poor prognosis in patients with bacterial meningitis [ 6 ]. In Indonesia, studies of NLR as a predictor of mortality in patients with bacterial meningitis have not been widely reported until the time this study was conducted.…”