Chuanyuan Tao1, Jiajing Wang2, Xin Hu1, Junpeng Ma1, Hao Li1, Chao You3. 1. Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China. 2. Department of Critical Care Medicine, Neurosurgical Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, People's Republic of China. 3. Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China. tcy106@163.com.
Abstract
BACKGROUND: Inflammation and thrombosis are associated with the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are emerging as novel inflammatory markers in stroke. We aimed to identify the association of NLR and PLR with delayed cerebral ischemia (DCI) and 3-month outcome after aSAH. METHODS: Two hundred and forty-seven patients diagnosed with aSAH within 24 h of symptoms onset were enrolled. Clinical, neuroradiological, laboratory, and follow-up data were collected from electronic database. Functional outcome was assessed by modified Rankin Scale. Admission NLR, PLR, and combined NLR-PLR associated with outcomes were evaluated by logistic regression analysis, and we used receiver operating characteristic curves to detect the overall predictive accuracy of these markers. RESULTS: Fifty-five (22.3 %) patients had unfavorable outcome and 47 (19 %) developed DCI. Both NLR and PLR were correlated with WFNS grade (ρ = 0.35[p < 0.001], ρ = 0.28[p < 0.001]) and modified Fisher grade (ρ = 0.25[p = 0.001], ρ = 0.28[p = 0.003]) and independently related to DCI (OR 2.18, 95 %CI 1.51-3.15, p = 0.016; OR 2.21, 95 %CI 1.61-3.32, p = 0.008) and functional outcome (OR 1.89, 95 %CI 1.52-3.17, p = 0.015; OR 1.77, 95 %CI 1.48-3.21, p = 0.018) at 3 months after aneurysm repair. They had comparable predictive ability in DCI occurrence (area under the curve [AUC] 0.65, 95 %CI 0.55-0.74, p = 0.002; AUC 0.68, 95 %CI 0.60-0.76, p < 0.001) and poor outcome (AUC 0.70, 95 %CI 0.63-0.77, p < 0.001; AUC 0.65, 95 %CI 0.58-0.72, p = 0.001). However, combination of the two indexes showed a better predictive value than each alone (AUC 0.73, 95 %CI 0.66-0.81, p < 0.001 for DCI; AUC 0.76, 95 %CI 0.70-0.83, p < 0.001 for poor outcome). CONCLUSIONS: NLR and PLR as novel inflammatory biomarkers are independent predictors of DCI development and functional outcome after acute aSAH. When combined together, they may help to identify high-risk patients more powerfully.
BACKGROUND: Inflammation and thrombosis are associated with the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are emerging as novel inflammatory markers in stroke. We aimed to identify the association of NLR and PLR with delayed cerebral ischemia (DCI) and 3-month outcome after aSAH. METHODS: Two hundred and forty-seven patients diagnosed with aSAH within 24 h of symptoms onset were enrolled. Clinical, neuroradiological, laboratory, and follow-up data were collected from electronic database. Functional outcome was assessed by modified Rankin Scale. Admission NLR, PLR, and combined NLR-PLR associated with outcomes were evaluated by logistic regression analysis, and we used receiver operating characteristic curves to detect the overall predictive accuracy of these markers. RESULTS: Fifty-five (22.3 %) patients had unfavorable outcome and 47 (19 %) developed DCI. Both NLR and PLR were correlated with WFNS grade (ρ = 0.35[p < 0.001], ρ = 0.28[p < 0.001]) and modified Fisher grade (ρ = 0.25[p = 0.001], ρ = 0.28[p = 0.003]) and independently related to DCI (OR 2.18, 95 %CI 1.51-3.15, p = 0.016; OR 2.21, 95 %CI 1.61-3.32, p = 0.008) and functional outcome (OR 1.89, 95 %CI 1.52-3.17, p = 0.015; OR 1.77, 95 %CI 1.48-3.21, p = 0.018) at 3 months after aneurysm repair. They had comparable predictive ability in DCI occurrence (area under the curve [AUC] 0.65, 95 %CI 0.55-0.74, p = 0.002; AUC 0.68, 95 %CI 0.60-0.76, p < 0.001) and poor outcome (AUC 0.70, 95 %CI 0.63-0.77, p < 0.001; AUC 0.65, 95 %CI 0.58-0.72, p = 0.001). However, combination of the two indexes showed a better predictive value than each alone (AUC 0.73, 95 %CI 0.66-0.81, p < 0.001 for DCI; AUC 0.76, 95 %CI 0.70-0.83, p < 0.001 for poor outcome). CONCLUSIONS: NLR and PLR as novel inflammatory biomarkers are independent predictors of DCI development and functional outcome after acute aSAH. When combined together, they may help to identify high-risk patients more powerfully.
Entities:
Keywords:
Aneurysmal subarachnoid hemorrhage; Delayed cerebral ischemia; Neutrophil to lymphocyte ratio; Outcome; Platelet to lymphocyte ratio
Authors: E Sander Connolly; Alejandro A Rabinstein; J Ricardo Carhuapoma; Colin P Derdeyn; Jacques Dion; Randall T Higashida; Brian L Hoh; Catherine J Kirkness; Andrew M Naidech; Christopher S Ogilvy; Aman B Patel; B Gregory Thompson; Paul Vespa Journal: Stroke Date: 2012-05-03 Impact factor: 7.914
Authors: Jose G Romano; Alejandro A Rabinstein; Kristopher L Arheart; Sandra Nathan; Iszet Campo-Bustillo; Sebastian Koch; Alejandro M Forteza Journal: J Neuroimaging Date: 2008-05-19 Impact factor: 2.486
Authors: Artur Nóbrega Lima Rodrigues de Morais; Victor Matheus Ribeiro Baylão; Tamires Martins Silva; Alexandra Gomes Dos Santos; Mayara Azevedo; Adilson J M de Oliveira Journal: Neurosurg Rev Date: 2021-02-15 Impact factor: 3.042
Authors: Jude P J Savarraj; Georgene W Hergenroeder; Liang Zhu; Tiffany Chang; Soojin Park; Murad Megjhani; Farhaan S Vahidy; Zhongming Zhao; Ryan S Kitagawa; H Alex Choi Journal: Neurology Date: 2020-11-12 Impact factor: 9.910
Authors: Lena Hueske; Tobias Bobinger; Antje Giede-Jeppe; Selim Atay; Julia Koehn; Anne Mrochen; Hannes Luecking; Philip Hoelter; Bastian Volbers; Hagen B Huttner Journal: Sci Rep Date: 2021-05-31 Impact factor: 4.379
Authors: Joseph R Geraghty; Tyler J Lung; Yonatan Hirsch; Eitan A Katz; Tiffany Cheng; Neil S Saini; Dilip K Pandey; Fernando D Testai Journal: Neurosurgery Date: 2021-11-18 Impact factor: 5.315