Neutrophil-to-lymphocyte ratio predicts hematoma growth in intracerebral hemorrhage

Abstract

Objective Early hematoma growth is a major determinant of early neurological deterioration and poor clinical outcome in patients with spontaneous intracerebral hemorrhage (ICH). Inflammation plays a major role in the pathophysiology of ICH. This study aimed to evaluate the potential of the neutrophil-to-lymphocyte ratio (NLR) for predicting early hematoma growth after ICH. Methods A retrospective review was performed of patients with acute spontaneous ICH who were admitted to the Stroke Center of the First People’s Hospital of Jingmen between January 2014 and January 2017. The NLR was computed from admission blood work. Brain computed tomography scans were performed at admission and repeated within 24 hours. Hematoma growth was defined as absolute growth >6 mL or relative growth >33%. Results A total of 123 patients were included and early hematoma growth occurred in 30 (24%) patients. Multivariate analysis showed that the NLR (odds ratio, 1.22; 95% confidence interval, 1.09–1.38) was independently associated with early hematoma growth. The best predictive cut-off of the NLR for early hematoma growth was 6.49 (sensitivity, 50%; specificity, 69%). Conclusions A high NLR is independently predictive of early hematoma growth and may aid in risk stratification of patients with ICH on admission.

Simvastatin boosts neutrophil apoptosis and ameliorates secondary brain injury following intracerebral hemorrhage via LXA4/FPR2/p38 MAPK pathway

“…[23][24][25][26][27] Recently, accumulating evidence supports that higher PMNs count and neutrophil to lymphocyte ratio (NLR) at early stage of ICH leads to the poorer outcome. [4][5][6][7] Thus, in a proof-of-concept experiment in rat model of ICH, we found that simvastatin effectively decreased the peripheral PMNs count, NLR and neutrophil brain-invading, as well as attenuated brain edema and neurological de cits following ICH.…”

“…Recently, clinical reports indicate that early peripheral blood polymorph nuclear neutrophils (PMNs) elevation is closely related to the poor prognosis of patients with ICH, which is often accompanied by heavier brain edema and larger hematoma. [4][5][6][7] To understand the relationship between the elevated PMNs and poor prognosis among ICH patients, we performed a con rmatory experiment in a rat model of ICH. [8] The results show that the ICH rat showed a signi cant increase of PMNs in peripheral blood at an early stage, which is consistent with the clinical phenomenon.…”

Role of C1q in spleen-derived neutrophil infiltration and neuroinflammation after ICH in mice

“…Accordingly, in this study we found a significant increase of microglia after ICH in mice and microglia activation peaked at 24 h after injury. Neutrophil-lymphocytes ratio (NLR) has been extensively reported as a risk factor associated with bad outcomes after ICH [23,33] Post-stroke immunological response has been extensively studied, especially in ischemia stroke [19].…”

“…After ischemic stroke, spleen was activated and the brainspleen cell cycling started. It is still controversial what plays the key role in the splenic response after stroke, the lymphocytes, monocytes, [22] neutrophil infiltration or the neutrophil-to-lymphocyte ratio (NLR) [23]. Moreover, it is worthwhile to elucidate the precise role of each cell type of spleen in secondary brain injury after stroke.…”

Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

“…In a previous study, Liu et al (2019) reported that a higher NLR level was significantly correlated with major disability at 90 days and a higher short-term mortality rate. Wang Z. et al (2019) suggested that NLR can predict hematoma expansion. Finally, Lattanzi et al (2017) indicated that NLR may be a prognostic factor for neurological deterioration.…”