Neutrophil-to-Lymphocyte Ratio and 30-Day Mortality in Patients with Acute Intracerebral Hemorrhage

• Published in: Journal of stroke and cerebrovascular diseases Vol. 25; no. 1; pp. 182 - 187
• Main Authors: Wang, Fei, MMed, Hu, Shanyou, BMed, Ding, Yong, BMed, Ju, Xuefeng, BMed, Wang, Li, BMed, Lu, Qiuxia, BMed, Wu, Xiao, BMed
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Area Under Curve; Cardiovascular; Cerebral Hemorrhage - blood; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - mortality; China - epidemiology; Female; Glasgow Coma Scale; Humans; intracerebral hemorrhage; Leukocyte Count; Lymphocyte Count; Lymphocytes; Male; Middle Aged; mortality; Neurology; Neutrophil-to-lymphocyte ratio; Neutrophils; Predictive Value of Tests; Prognosis; Radiography; Risk Factors; ROC Curve; Sensitivity and Specificity; Single-Blind Method; intracerebral hemorrhage; mortality; risk factors; Neutrophil-to-lymphocyte ratio; prognosis
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.013

Background Although a highly significant association has been described between neutrophil-to-lymphocyte ratio (NLR) and mortality in patients with various types of stroke, the association between NLR and mortality in intracerebral hemorrhage (ICH) patients remains unclear. Methods In this observational study, we enrolled 224 ICH patients. They were divided into 2 groups based on their 30-day outcomes. Multivariate logistic regression was performed to identify independent risk factors of 30-day mortality. An optimal cutoff value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between the survival and death groups. Results Among 224 patients, 26 died. No significant difference in NLR at admission was observed between the 2 groups (surviving: 2.39 ± 1.75 versus nonsurviving: 3.09 ± 2.16, P   =  .065), whereas NLR on the next morning following admission was significantly higher in the patients who died (12.53 ± 9.33) than in those who survived (5.53 ± 4.68) ( P  <   .001). On multivariate logistic analysis, Glasgow Coma Scale score (odds ratio [OR] .805, 95% confidence interval [CI] .661-.979, P  = .030), age (≥80 years; OR .203, CI .055-.750, P  = .017), ICH volume (≥30 cm3 ; OR .112, CI .108-.699, P  = .019), and NLR on the next morning (OR 1.091, CI 1.002-1.188, P  = .044) were independent risk factors of 30-day mortality. An NLR of 7.35 was identified as the optimal cutoff value. The area under the curve of NLR for 30-day mortality was .762 ( P  < .001). The mortality was significantly higher in patients with an NLR of 7.35 or higher than in those with an NLR less than 7.35 (31.6% versus 4.8%, P  <   .001). Conclusions Higher NLR exhibited an increased mortality in ICH patients. NLR could be used to predict 30-day outcome in ICH patients.