Research Article: Early increased neutrophil-to-lymphocyte ratio is associated with poor 3-month outcomes in spontaneous intracerebral hemorrhage

Date Published: February 7, 2019

Publisher: Public Library of Science

Author(s): Jie Qin, Zhu Li, Guangming Gong, Hongwei Li, Ling Chen, Bo Song, Xinjing Liu, Changhe Shi, Jing Yang, Ting Yang, Yuming Xu, Xiaoying Wang.


The aim of this study was to evaluate the association of dynamic neutrophil-to-lymphocyte ratio (NLR) with 3-month functional outcomes in patients with sICH. We retrospectively identified 213 consecutive patients with sICH hospitalized in The First Affiliated Hospital of Zhengzhou University from January 2017 to May 2018. Patients were divided into functional independence (FI) or unfavorable prognosis (UP) groups based on 3-month outcomes. Admission leukocyte counts within 24 hours of symptom onset were obtained, and the recorded fraction, of which the numerator is neutrophil and the denominator is lymphocyte, as NLR0. Determined NLR1, NLR3, NLR7, and NLR14 were recorded on day 1 (n = 77), day 3 (n = 126), day 7 (n = 123), and day 14 (n = 105), respectively. The relationships between dynamic NLR or leukocyte counts and clinical features were evaluated using Spearman’s or Kendall’s correlation analysis. Logistic regression analyses were used to identify the risk factors for unfavorable 3-month prognosis. The patients’ dynamic NLR was positively associated with the National Institutes of Health Stroke Scale, ICH score, and hematoma volume at admission, while inversely correlated to the onset GCS score and FI at 3-month follow-up. Furthermore, higher NLR or lower absolute lymphocyte count obtained at admission was independently risk factor for UP at 3 months (adjusted odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.003, 1.12; OR: 0.41, 95% CI: 0.18, 0.94, respectively). In conclusion, higher NLR and lower lymphocyte counts at early stages were predictive of 3-month unfavorable outcomes in sICH patients.

Partial Text

Spontaneous intracerebral hemorrhage (sICH) accounts for approximately 70% of hemorrhagic strokes, with high mortality, morbidity, and disability rates [1]. It is one of the most devastating diseases globally, especially in developing countries [2]. For improving the outcomes in sICH, existing surgical or medical treatments are insufficient [3, 4].

The main findings of our study were that higher NLR or lower ALC in patients with sICH during the early stage of hospitalization was independently associated with 3-month outcomes, after adjusting for confounders, including NIHSS score, hematoma volume on admission, and infections from admission to day 14 of hospitalization.




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