Neutrophil-to-Lymphocyte Ratio and Prognosis of Spontaneous Intracerebral Hemorrhage

• Main Authors: Mehmet Yasir Pektezel, Ethem Murat Arsava, Doğan Dinç Öge, Özlem Kayım Yıldız, Mehmet Akif Topçuoğlu
• Format: Article
• Language: English
• Published: Turkish Society of Cerebrovascular Diseases 2019-08-01
• Series: Türk Beyin Damar Hastalıkları Dergisi
• Subjects: Stroke; Adrenal; Stress; Complete blood count; Pneumonia
• Online Access: https://www.journalagent.com/tbdhd/pdfs/TBDHD-87587-RESEARCH_ARTICLE-TOPCUOGLU.pdf

INTRODUCTION: Neutrophil to Lymphocyte Ratio (NLR) is suggested to predict functional outcomes and mortality at admission of patients with intracerebral hemorrhage (ICH). However, effect of timing of NLR measurement on prediction of mortality and expansion in ICH has not been clarified. METHODS: From admission and 24th-hour blood samples, admission NLR (NLR-adm) and 24th-hour NLR (NLR-24th) was calculated as “absolute neutrophil count/lymphocyte count”. Hematoma expansion was evaluated with the volume (ABC/2) difference from admission cranial CT to follow-up one. RESULTS: A total of 383 patients (41.7% female, age, 65±13) were assessed. Of them, 251 (65.5%) were discharged. The average hematoma volume was 32.8 cc and 35.3 cc in the first and second CT, respectively. The mean NLR was 8.2±10.3 at admission and 16.6 ± 15.7 at 24th hour. Only NLR-24th (β=0.035, OR: 1.036 (1.002-1.071), p=0.04), hematoma volume at first CT (β=0.012, OR 1.012 (0.999-1.024) p=0.067) and Hemphill score (β=0.689, OR 1.992 (1.402-2.832) p<0.001) were found to be significantly related with mortality after adjusted to age (decade), atrial fibrillation, anticoagulant use and NLR-adm. An exploratory logistic regression analysis indicated that hematoma expansion greater than 12.5 cc correlated to, albeit borderline, NLR-24th (β=0.038, OR=1.038 (95%CI: 1.008-1.069) but not NLR-adm. DISCUSSION AND CONCLUSION: We found NLR-24th to be associated with higher mortality and greater hematoma expansion rate. This NLR increment, probably secondary to the stress response, in ICH can be considered as an epiphenomenon of worse prognosis.