Neutrophil-to-Lymphocyte Ratio as an Independent Predictor of In-Hospital Mortality in Patients with Acute Intracerebral Hemorrhage
Open Access
- 15 June 2021
- Vol. 57 (6), 622
- https://doi.org/10.3390/medicina57060622
Abstract
Background and Objectives: Neutrophil-to-lymphocyte ratio (NLR), a very low cost, widely available marker of systemic inflammation, has been proposed as a potential predictor of short-term outcome in patients with intracerebral hemorrhage (ICH). Methods: Patients with ICH admitted to the Neurology Department during a two-year period were screened for inclusion. Based on eligibility criteria, 201 patients were included in the present analysis. Clinical, imaging, and laboratory characteristics were collected in a prespecified manner. Logistic regression models and receiver operating characteristics (ROC) curves were used to assess the performance of NLR assessed at admission (admission NLR) and 72 h later (three-day NLR) in predicting in-hospital death. Results: The median age of the study population was 70 years (IQR: 61–79), median admission NIHSS was 16 (IQR: 6–24), and median hematoma volume was 13.7 mL (IQR: 4.6–35.2 mL). Ninety patients (44.8%) died during hospitalization, and for 35 patients (17.4%) death occurred during the first three days. Several common predictors were significantly associated with in-hospital mortality in univariate analysis, including NLR assessed at admission (OR: 1.11; 95% CI: 1.04–1.18; p = 0.002). However, in multivariate analysis admission, NLR was not an independent predictor of in-hospital mortality (OR: 1.04; 95% CI: 0.9–1.1; p = 0.3). The subgroup analysis of 112 patients who survived the first 72 h of hospitalization showed that three-day NLR (OR: 1.2; 95% CI: 1.09–1.4; p < 0.001) and age (OR: 1.05; 95% CI: 1.02–1.08; p = 0.02) were the only independent predictors of in-hospital mortality. ROC curve analysis yielded an optimal cut-off value of three-day NLR for the prediction of in-hospital mortality of ≥6.3 (AUC = 0.819; 95% CI: 0.735–0.885; p < 0.0001) and Kaplan–Meier analysis proved that ICH patients with three-day NLR ≥6.3 had significantly higher odds of in-hospital death (HR: 7.37; 95% CI: 3.62–15; log-rank test; p < 0.0001). Conclusion: NLR assessed 72 h after admission is an independent predictor of in-hospital mortality in ICH patients and could be widely used in clinical practice to identify the patients at high risk of in-hospital death. Further studies to confirm this finding are needed.Keywords
This publication has 27 references indexed in Scilit:
- Stroke-induced immunosuppression and poststroke infectionStroke and Vascular Neurology, 2018
- Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral HemorrhageCerebrovascular Diseases, 2017
- Temporal trends in early case-fatality rates in patients with intracerebral hemorrhageNeurology, 2017
- The Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS): Development and assessment of reliabilityJournal of the Neurological Sciences, 2016
- Neutrophil-to-Lymphocyte Ratio and 30-Day Mortality in Patients with Acute Intracerebral HemorrhageJournal of Stroke and Cerebrovascular Diseases, 2016
- Serum Low-Density Lipoprotein Cholesterol Level Predicts Hematoma Growth and Clinical Outcome After Acute Intracerebral HemorrhageStroke, 2011
- Incidence and 10-Year Survival of Intracerebral Hemorrhage in a Population-Based RegistryStroke, 2009
- The ICH ScoreStroke, 2001
- The ABCs of Measuring Intracerebral Hemorrhage VolumesStroke, 1996
- Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis.Radiology, 1982