Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage

// Simona Lattanzi 1 , Claudia Cagnetti 1 , Leandro Provinciali 1 and Mauro Silvestrini 1 1 Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy Correspondence to: Simona Lattanzi, email: // Keywords : cerebrovascular disease, intra-cerebral hemorrhage, lymphocyte, neutrophil, neutrophil-to-lymphocyte ratio Received : January 04, 2017 Accepted : February 08, 2017 Published : February 16, 2017 Abstract Immunity plays key roles in pathophysiology of intracerebral hemorrhage (ICH). The aim of the study was to determine whether the peripheral leukocyte count and neutrophil-to-lymphocyte ratio (NLR) predicted neurological deterioration (ND) after ICH. We identified consecutive patients with ICH who had blood sampling performed within 24 hours from symptom’s onset. Total white blood cells (WBC), absolute neutrophil count (ANC) and absolute lymphocyte count (ALC) were retrieved, and the NLR computed as the ratio of the ANC to ALC values. The study endpoint was the occurrence of neurological deterioration (ND) within 7 days after ICH. One hundred ninety-two subjects were enrolled, whose 54 (28.1%) presented ND. At multivariate analysis, the WBC (adjusted odd ratio [ adj OR] for 1,000 leukocytes increase 1.29, 95% confidence interval [CI] 1.11-1.50), ANC ( adj OR for 1,000 neutrophils increase 1.61, 95% CI 1.30-1.99), ALC ( adj OR for 1,000 lymphocytes increase 0.21, 95% CI 0.09-0.49) and NLR ( adj OR for 1-point increase 1.65, 95% CI 1.36-2.00) were independently associated with ND (p≤0.001). The NLR resulted the best discriminating variable for the occurrence of the adverse outcome (area under the curve 0.888, 95% CI 0.832-0.945; p < 0.001). The NLR predicted ND after acute ICH and can aid in the risk stratification of patients.