Neutrophil to lymphocyte ratio for intracerebral hemorrhage

Inflammatory response plays a vital role in the pathological mechanism of intracerebral hemorrhage. It has been recently reported that neutrophil to lymphocyte ratio (NLR) could represent a novel composite inflammatory marker for predicting the prognosis of intracranial hemorrhage (ICH).


The clinical data of 558 consecutive patients from the Ulanqab Central Hospital, with intracerebral hemorrhage (ICH) were retrospectively analyzed. Neutrophil to lymphocyte ratio is calculated by absolute lymphocyte count divided by absolute monocyte count.

Of these patients, 166 patients experienced neurological deterioration (ND) during the first week after admission and 72 patients died within 90 days. Multivariate analysis indicated that white blood cells (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio (NLR), LMR were significantly associated with ND during the initial week after ICH onset and also were associated with 90-day mortality. Moreover, NLR and LMR showed a higher predictive ability in ND during the initial week after ICH onset than 90-day mortality in receiver operating characteristic analysis. The best cut-off points of NLR and LMR in predicting ND and 90-day mortality were 10.24 and 2.21 and 16.81 and 2.19, respectively.

The results suggest that LMR on admission is a predictive factor for ND during the initial week after ICH onset, as well as 90-day mortality 1).


104 patients with acute ICH admitted to West China Hospital, Sichuan University, ChengduChina, from October 2016 to January 2018 were retrospectively enrolled. Admission absolute neutrophil count, lymphocyte count and white blood count were extracted from electronic medical records of patents with ICH. The associations between outcome and laboratory biomarkers were assessed by multivariable logistic regression analysis. The comparison of predictive power of independent predictors was evaluated by receiver operating characteristic curves (ROC).

59 ICH patients with surgical treatment exhibited unfavorable outcome, which associated with higher admission NLR (OR 0.692, 95%CI 0.518-0.925, P=0.01; OR 1.148, 95%CI 1.078-1.222, P<0.01; OR 1.215, 95%CI 1.015-1.454, P=0.03), lower GCS and larger hematoma. NLR showed the best predictive power by comparing with other laboratorial variables (area under the curve [AUC] 0.668, 95%CI 0.569-0.757, P<0.01), and was also found to linearly correlate with GCS at admission, hematoma volume, ANC, ALC and hydrocephalus. Meanwhile, the best predictive cutoff point of 6.46 for NLR was also identified.

Other than the association of prognosis of ICH patients, NLR exhibited potential independently predictive ability for 90-day functional outcome of ICH patients after surgery 2).

1)

Qi H, Wang D, Deng X, Pang X. Lymphocyte-to-Monocyte Ratio Is an Independent Predictor for Neurological Deterioration and 90-Day Mortality in Spontaneous Intracerebral Hemorrhage. Med Sci Monit. 2018 Dec 20;24:9282-9291. doi: 10.12659/MSM.911645. PubMed PMID: 30572340.
2)

F Z, C T, X H, J Q, X L, C Y, Y J, M Y. Association of neutrophil to lymphocyte ratio on 90-day functional outcome in intracerebral hemorrhage patients undergoing surgical treatment. World Neurosurg. 2018 Aug 10. pii: S1878-8750(18)31791-1. doi: 10.1016/j.wneu.2018.08.010. [Epub ahead of print] PubMed PMID: 30103056.

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