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

Abstract

The neutrophil-to-lymphocyte ratio (NLR) plays an important role in the progression of intracerebral hemorrhage (ICH). An increasing number of studies have reported that a high NLR is correlated with poor clinical outcomes among patients with ICH. Here, we conducted a systematic review and meta-analysis to evaluate the prognostic value of NLR in the setting of ICH. We performed a comprehensive search of electronic literature databases to identify all relevant studies evaluating the prognostic role of NLR in patients with ICH. Two researchers independently screened the studies and extracted relevant data. We extracted, pooled, and weighted odds ratio (OR) and 95% confidence interval (CI) values using a generic inverse-variance method, and then evaluated the heterogeneity among studies using Q test and I2 statistic. Finally, we selected a total of 26 studies including 7,317 patients for the current study. Overall, our results indicated that a high NLR was significantly associated with a poor outcome (OR, 1.32; 95% CI, 1.19–1.46; P < 0.00001), mortality (OR, 1.05; 95% CI, 1.01–1.09; P = 0.02), and neurological deterioration (OR, 1.65; 95% CI, 1.08–2.52; P = 0.02). We did not observe a significant association between NLR and hematoma expansion (OR, 1.04; 95% CI, 0.99–1.08; P = 0.09). Our study indicated that a high NLR is significantly associated with poor clinical outcomes in patients with ICH. As NLR is a simple and easily available biomarker, future studies should focus on exploring its application in the prognostic evaluation of patients with ICH.

“Rogue” [DEspR+CD11b+] neutrophil subset correlates with severity in spontaneous intracerebral hemorrhage

“…The correlation of DEspR+CD11b+ neutrophil counts with NET+ neutrophil counts indicates a predisposition of DEspR+ neutrophils to intravascular NET formation. Based on known neutrophil- and NET-mediated cell injury mechanisms ( 26 ), DEspR+CD11b+ rogue neutrophils prone to NET-formation could provide injury mechanisms that contribute to the association of high NLR with worse in-hospital mortality ( 27 ), worse 90-day outcomes in sICH ( 28 , 29 ), and the association of high postoperative NLR with mortality after hematoma evacuation ( 30 ). These relational observations are represented in the very strong correlation ( r > 0.94) detected for the 4-marker combination stronger than the ICH score or any neutrophil marker alone in this study and consistent with an earlier report of a stronger association of combined NLR and modified ICH score with 30-day mRS ( 31 , 32 ).…”

The predictive value of neutrophil to lymphocyte ratio on 30-day outcomes in spontaneous intracerebral hemorrhage patients after surgical treatment: A retrospective analysis of 128 patients

“…More than that, the current prognostic evaluation model of patients with ICH, such as ICH score, is mainly based on clinical information and lacks corresponding attention to laboratory biomarkers. Our study on the prognostic value of NLR provided new ideas for exploring new prognostic indicators with clinical significance ( 30 ).…”

The Clinical Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Predicting Hematoma Expansion and Poor Outcomes in Patients with Acute Intracerebral Hemorrhage

“…When ICH occurs, neutrophils are known as the first inflammatory cells to invade the brain parenchyma [20]. Therefore, NLR could be a complex index that reflects systemic inflammatory status [21] and was recently identified as a novel marker for predicting several outcomes after ICH [22]. Nonetheless, evidence of the predictive value of NLR for HE in patients with acute ICH was still lacking [23][24][25].…”