Admission neutrophil count and neutrophil to lymphocyte ratio predict 90-day outcome in intracerebral hemorrhage
Abstract
Aim: Inflammation plays a role in secondary brain injury after intracerebral hemorrhage (ICH). We aimed to determine the prognostic significance of admission white blood cell (AWC), neutrophil count (ANC), lymphocyte count, monocyte count and neutrophil to lymphocyte ratio (NLR) for 90-day outcome after ICH. Patients & methods: A total of 336 patients with spontaneous ICH were retrospectively investigated. Clinical outcome was assessed by modified Rankin Scale at 90 days. Results: Multivariate analysis showed that higher AWC, ANC, NLR were independently associated with mortality and worse outcome. Moreover, NLR showed a higher predictive ability in mortality than in poor outcome in receiver operating characteristic analysis. Linear regression analyses revealed admission Glasgow Coma Scale score and ICH volume were mostly correlated with these indices. Conclusion: Elevated levels of AWC, ANC and NLR were independently related to poor 90-day outcome after ICH. NLR may be a novel inflammatory biomarker following ICH.
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1 Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46(7), 2032–2060 (2015).
- 2 . Molecular pathophysiology of cerebral hemorrhage: secondary brain injury. Stroke 42(6), 1781–1786 (2011).
- 3 . Preclinical and clinical research on inflammation after intracerebral hemorrhage. Prog. Neurobiol. 92(4), 463–477 (2010).
- 4 . Neutrophil depletion reduces blood–brain barrier breakdown, axon injury, and inflammation after intracerebral hemorrhage. J. Neuropathol. Exp. Neurol. 70(3), 218–235 (2011).
- 5 Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology 63(3), 461–467 (2004).
- 6 Monocyte count and 30-day case fatality in intracerebral hemorrhage. Stroke 46(8), 2302–2304 (2015).
- 7 . Neutrophil-to-lymphocyte ratio predicts the outcome of acute intracerebral hemorrhage. Stroke 47(6), 1654–1657 (2016). • This is the second report regarding the relationship between admission neutrophil to lymphocyte ratio (NLR) and outcome after acute intracerebral hemorrhage, finding that admission NLR is a positive acute-phase reactant.
- 8 Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev. Cardiovasc. Ther. 11(1), 55–59 (2013).
- 9 . Is neutrophil/lymphocyte ratio predict to short-term mortality in acute cerebral infarct independently from infarct volume? J. Stroke Cerebrovasc. Dis. 23(8), 2163–2168 (2014).
- 10 Neutrophil-to-lymphocyte ratio and 30-day mortality in patients with acute intracerebral hemorrhage. J. Stroke Cerebrovasc. Dis. 25(1), 182–187 (2016). • This is the first report concerning the prognostic value of admission NLR after acute intracerebral hemorrhage, showing NLR on the next morning following admission rather than NLR at admission was significantly associated with 30-day mortality.
- 11 Severe renal dysfunction and risk factors associated with renal impairment in HIV-infected adults in Africa initiating antiretroviral therapy. Clin. Infect. Dis. 46(8), 1271–1281 (2008).
- 12 Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology 69(13), 1356–1365 (2007).
- 13 Effects of plasma D-dimer levels on early mortality and long-term functional outcome after spontaneous intracerebral hemorrhage. J. Clin. Neurosci. 21(8), 1364–1367 (2014).
- 14 . Inflammation after intracerebral hemorrhage. J. Cereb. Blood Flow Metab. 27(5), 894–908 (2007).
- 15 . Leukocyte invasion of the brain after experimental intracerebral hemorrhage in mice. Stroke 45(7), 2107–2114 (2014).
- 16 . Polymorphonuclear leukocytes promote neurotoxicity through release of matrix metalloproteinases, reactive oxygen species, and TNF-alpha. J. Neurochem. 102(3), 900–912 (2007).
- 17 . Neuroprotection by inhibition of matrix metalloproteinases in a mouse model of intracerebral haemorrhage. Brain 128(Pt 7), 1622–1633 (2005).
- 18 Peripheral monocyte count is associated with case fatality after intracerebral hemorrhage. J. Stroke Cerebrovasc. Dis. 23(2), e107–e111 (2014).
- 19 Leukocyte count and intracerebral hemorrhage expansion. Stroke 47(6), 1473–1478 (2016).
- 20 Lymphocytopenia is an independent predictor of unfavorable functional outcome in spontaneous intracerebral hemorrhage. Stroke 47(5), 1239–1246 (2016).
- 21 Letter by Hu et al. regarding article, “Monocyte count and 30-day case fatality in intracerebral hemorrhage”. Stroke 46(11), e243 (2015).
- 22 . Assessment of systemic cellular inflammatory response after spontaneous intracerebral hemorrhage. Clin. Neurol. Neurosurg. 150, 72–79 (2016).
- 23 . Neutrophil lymphocyte ratio as a predictor of stroke. J. Stroke Cerebrovasc. Dis. 22(7), 1169–1174 (2013).
- 24 Admission neutrophil-lymphocyte ratio predicts 90 day outcome after endovascular stroke therapy. J. Neurointerv. Surg. 6(8), 578–583 (2014).
- 25 . Inflammation in intracerebral hemorrhage: from mechanisms to clinical translation. Prog. Neurobiol. 115, 25–44 (2014).
- 26 . Systemic inflammatory response syndrome predicts severity of stroke and outcome. J. Stroke Cerebrovasc. Dis. 24(7), 1640–1648 (2015).
- 27 Systemic inflammatory response syndrome and outcomes in intracerebral hemorrhage. Neurocrit. Care 25(1), 133–140 (2016).
- 28 Stroke-induced immunodepression: experimental evidence and clinical relevance. Stroke 38(Suppl. 2), 770–773 (2007).
- 29 Neurogenic pulmonary edema in patients with nontraumatic intracerebral hemorrhage: predictors and association with outcome. Anesth. Analg. 116(4), 855–861 (2013).
- 30 Prognostic significance of hyperglycemia in acute intracerebral hemorrhage: the INTERACT2 study. Stroke 47(3), 682–688 (2016).
- 31 . Age-related comparisons of evolution of the inflammatory response after intracerebral hemorrhage in rats. Transl. Stroke Res. 3(Suppl. 1), 132–146 (2012).
- 32 Neutrophil-to-lymphocyte ratio positively correlates to age in healthy population. J. Clin. Lab. Anal. 29(6), 437–443 (2015).
- 33 The neutrophil-to-lymphocyte ratio correlates with age in patients with papillary thyroid carcinoma. ORL J. Otorhinolaryngol. Relat. Spec. 77(2), 109–116 (2015).