scholarly journals Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage

2017 ◽  
Vol 44 (1-2) ◽  
pp. 26-34 ◽  
Author(s):  
Antje Giede-Jeppe ◽  
Tobias Bobinger ◽  
Stefan T. Gerner ◽  
Jochen A. Sembill ◽  
Maximilian I. Sprügel ◽  
...  

Background and Purpose: Stroke-associated immunosuppression and inflammation are increasingly recognized as factors that trigger infections and thus, potentially influence the outcome after stroke. Several studies demonstrated that elevated neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of adverse outcomes in patients with ischemic stroke. However, little is known about the impact of NLR on short-term mortality in intracerebral hemorrhage (ICH). Methods: This observational study included 855 consecutive ICH-patients. Patient demographics, clinical, laboratory, and in-hospital measures as well as neuroradiological data were retrieved from institutional databases. Functional 3-months-outcome was assessed and categorized as favorable (modified Rankin Scale [mRS] 0-3) and unfavorable (mRS 4-6). We (i) studied the natural course of NLR in ICH, (ii) analyzed parameters associated with NLR on admission (NLROA), and (iii) evaluated the clinical impact of NLR on mortality and functional outcome. Results: The median NLROA of the entire cohort was 4.66 and it remained stable during the entire hospital stay. Patients with NLR ≥4.66 showed significant associations with poorer neurological status (National Institute of Health Stroke Scale [NIHSS] 18 [9-32] vs. 10 [4-21]; p < 0.001), larger hematoma volume on admission (17.6 [6.9-47.7] vs. 10.6 [3.8-31.7] mL; p = 0.001), and more frequently unfavorable outcome (mRS 4-6 at 3 months: 317/427 [74.2%] vs. 275/428 [64.3%]; p = 0.002). Patients with an NLR under the 25th percentile (NLR <2.606) - compared to patients with NLR >2.606 - presented with a better clinical status (NIHSS 12 [5-21] vs. 15 [6-28]; p = 0.005), lower hematoma volumes on admission (10.6 [3.6-30.1] vs. 15.1 [5.7-42.3] mL; p = 0.004) and showed a better functional outcome (3 months mRS 0-3: 82/214 [38.3%] vs. 185/641 [28.9%]; p = 0.009). Patients associated with high NLR (≥8.508 = above 75th-percentile) showed the worst neurological status on admission (NIHSS 21 [12-32] vs. 12 [5-23]; p < 0.001), larger hematoma volumes (21.0 [8.6-48.8] vs. 12.2 [4.1-34.9] mL; p < 0.001), and higher proportions of unfavorable functional outcome at 3 months (mRS 4-6: 173/214 vs. 418/641; p < 0.001). Further, NLR was linked to more frequently occurring infectious complications (pneumonia 107/214 vs. 240/641; p = 0.001, sepsis: 78/214 vs. 116/641; p < 0.001), and increased c-reactive-protein levels on admission (p < 0.001; R2 = 0.064). Adjusting for the above-mentioned baseline confounders, multivariable logistic analyses revealed independent associations of NLROA with in-hospital mortality (OR 0.967, 95% CI 0.939-0.997; p = 0.029). Conclusions: NLR represents an independent parameter associated with increased mortality in ICH patients. Stroke physicians should focus intensely on patients with increased NLR, as these patients appear to represent a population at risk for infectious complications and increased short-mortality. Whether these patients with elevated NLR may benefit from a close monitoring and specially designed therapies should be investigated in future studies.

2020 ◽  
Vol 132 (2) ◽  
pp. 400-407 ◽  
Author(s):  
Antje Giede-Jeppe ◽  
Jonathan Reichl ◽  
Maximilian I. Sprügel ◽  
Hannes Lücking ◽  
Philip Hoelter ◽  
...  

OBJECTIVEStroke-associated immunosuppression and inflammation are increasingly recognized as factors triggering infections and thus potentially influencing outcome after stroke. Several studies have demonstrated that elevated neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of adverse outcomes for patients with ischemic stroke or intracerebral hemorrhage. Thus far, in patients with subarachnoid hemorrhage the association between NLR and outcome is insufficiently established. The authors sought to investigate the association between NLR on admission and functional outcome in aneurysmal subarachnoid hemorrhage (aSAH).METHODSThis observational study included all consecutive aSAH patients admitted to a German tertiary center over a 5-year period (2008–2012). Data regarding patient demographics and clinical, laboratory, and in-hospital measures, as well as neuroradiological data, were retrieved from institutional databases. Functional outcome was assessed at 3 and 12 months using the modified Rankin Scale (mRS) score and categorized into favorable (mRS score 0–2) and unfavorable (mRS score 3–6). Patients’ radiological and laboratory characteristics were compared between aSAH patients with favorable and those with unfavorable outcome at 3 months. In addition, multivariate analysis was conducted to investigate parameters independently associated with favorable outcome. Receiver operating characteristic (ROC) curve analysis was undertaken to identify the best cutoff for NLR to discriminate between favorable and unfavorable outcome in these patients. To account for imbalances in baseline characteristics, propensity score matching was carried out to assess the influence of NLR on outcome measures.RESULTSOverall, 319 patients with aSAH were included. Patients with unfavorable outcome at 3 months were older, had worse clinical status on admission (Glasgow Coma Scale score and Hunt and Hess grade), greater amount of subarachnoidal and intraventricular hemorrhage (modified Fisher Scale grade and Graeb score), and higher rates of infectious complications (pneumonia and sepsis). A significantly higher NLR on admission was observed in patients with unfavorable outcome according to mRS score (median [IQR] NLR 5.8 [3.0–10.0] for mRS score 0–2 vs NLR 8.3 [4.5–12.6] for mRS score 3–6; p < 0.001). After adjustments, NLR on admission remained a significant predictor for unfavorable outcome in SAH patients (OR [95% CI] 1.014 [1.001–1.027]; p = 0.028). In ROC analysis, an NLR of 7.05 was identified as the best cutoff value to discriminate between favorable and unfavorable outcome (area under the curve = 0.614, p < 0.001, Youden’s index = 0.211; mRS score 3–6: 94/153 [61.4%] for NLR ≥ 7.05 vs 67/166 [40.4%] for NLR < 7.05; p < 0.001). Subanalysis of patients with NLR levels ≥ 7.05 vs < 7.05, performed using 2 propensity score–matched cohorts (n = 133 patients in each group), revealed an increased proportion of patients with unfavorable functional outcome at 3 months in patients with NLR ≥ 7.05 (mRS score 3–6 at 3 months: NLR ≥ 7.05 82/133 [61.7%] vs NLR < 7.05 62/133 [46.6%]; p = 0.014), yet without differences in mortality at 3 months (NLR ≥ 7.05 37/133 [27.8%] vs NLR < 7.05 27/133 [20.3%]; p = 0.131).CONCLUSIONSAmong aSAH patients, NLR represents an independent parameter associated with unfavorable functional outcome. Whether the impact of NLR on functional outcome is related to preexisting comorbidities or represents independent causal relationships in the context of stroke-associated immunosuppression should be investigated in future studies.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Achint Patel ◽  
Sopan Lahewala ◽  
Neil Patel ◽  
Girish N Nadkarni ◽  
Grishma Dhaduk ◽  
...  

Background: The impact of do-not-resuscitate (DNR) orders on outcomes has not been systematically evaluated in Intracerebral Hemorrhage (ICH). Hypothesis: We assessed the impact of DNR orders in ICH and its association to mortality/related adverse outcomes. Methods: We reviewed the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample(NIS) database of 2011 for ICH using ICD 9-CM codes(431).This represents 20% of all US hospital patients and weighted numbers represent national estimates. We defined patients’ DNR status with ICD code V49.86 and comorbid conditions by Deyo’s modification of Charlson’s Comorbidity Index (CCI). We only included adult patients in our analysis. Our primary outcomes of interest were in-hospital mortality and adverse outcome (composite of mortality & discharge other than home). We utilized chi-square test for univariable analysis for categorical variables and generated hierarchical multilevel regression models to determine independent predictors of mortality and adverse outcome. Results: We analyzed a total of 13440 pts (weighted n= 64617) with ICH of which 2029 (weighted n=9713) patients had DNR status. The proportions of mortality (56% vs. 19%, p<0.001) and adverse outcome(89% vs 70%) were higher in patients with DNR orders. Even after adjusting for confounders (demographics, Deyo’s modification of charlson’s co-morbidity index, admission type (elective vs emergent), hospital region, hospital teaching status, hospital ICH volume and primary payer), DNR status was associated with higher in hospital mortality (OR 6.98, 95% CI 6.58-7.41), p<0.001) and higher odds of adverse outcome (OR 3.98, 95% CI 3.64-4.34, p<0.001). Conclusion: DNR status in patients admitted with ICH appears to be a independent and significant predictor of substantially increased hospital mortality and adverse outcomes. The reasons for this are multifactorial and likely involve patient as well as systematic factors.Further studies including both quantitative/qualitative aspects are warranted to investigate these factors in detail.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 8-9
Author(s):  
Binbin Zheng ◽  
Qian Wang ◽  
Sridevi Rajeeve ◽  
Biyue Dai ◽  
Cynthia Zevallos ◽  
...  

INTRODUCTION: Cerebral Venous Sinus Thrombosis (CVST) primarily affects children and young adults, especially young women of child-bearing age. Despite overall favorable outcome with systemic anticoagulation, it is still associated with up to 15% mortality and a high incidence of morbidity, resulting in a significant loss of productive life. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) are inflammatory and immunologic serum biomarkers that have been described to be predictive of outcome in arterial and venous thromboembolism events including pulmonary embolism and ischemic stroke. Nonetheless, predictive values of these ratios in CVST are not well established. METHODS: This is a single-center, observational and retrospective study that included patients diagnosed with CVST from January 2004 to December 2016 in University of Iowa Hospitals and Clinics. Patients with age older than 18 years were included. Exclusion criteria were incomplete clinical or laboratory data and patients with active malignancy receiving chemotherapy at the time of CVST diagnosis. Patients' complete blood count obtained at admission was used for ratio calculation. Receiver Operating Characteristic (ROC) curve was used to determine cutoff value for the ratios. Predictive utility of each ratio was evaluated in separate multivariate logistic regression models, conditioned on variables that were already shown to have strong association with mRS outcome in univariate analyses. An Akaike information criterion (AIC)-based backward stepwise selection scheme was used for model selection. Functional outcome was assessed by using modified Rankin score (mRS) which was into good outcome (mRS score of 0 to 2) and poor outcome (mRS score of 3 to 6). A two-sided p-value of 0.05 was considered statistically significant. RESULTS: 134 patients were included; median age was 42 years (IQR = 26.75 years) and 90 (67%) were female. The overall mortality was 9% (N=13). After adjusting by demographic characteristics, presenting symptoms and comorbidities, NLR&gt;6.24 (OR=4.57, 95% CI 1.85 - 11.29, p=0.001) and PLR&gt;144 (OR=4.80, 95% CI 1.95 - 11.82, p=0.001) were statistically associated with poor mRS (mRS 3-6) at hospital discharge. Altered mental status on presentation was independently correlated with poor neurologic outcome and in-hospital mortality. While altered motor function and concomitant infection correlated with higher mRS and higher mortality, respectively. The present study did not observe significant prediction between ratios and in-hospital mortality, being NLR marginally significant (OR= 4.67, 95% CI 0.85 - 25.67, p=0.077). CONCLUSION: To the best of our knowledge, this is the first study that describes a statistically significant association between increased NLR and PLR at admission and poor functional outcome in CVST patients at discharge. Their predictive value could be potentially used in the early identification of high-risk patients who may benefit from more aggressive therapeutic approaches, such as endovascular treatment. Disclosures No relevant conflicts of interest to declare.


Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 622
Author(s):  
Răzvan Alexandru Radu ◽  
Elena Oana Terecoasă ◽  
Cristina Tiu ◽  
Cristina Ghiță ◽  
Alina Ioana Nicula ◽  
...  

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.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Wanchun Yang ◽  
Yunbo Yuan ◽  
Junhong Li ◽  
Yuli Shuai ◽  
Xiang Liao ◽  
...  

Background. The combination of plasma fibrinogen and neutrophil to lymphocyte ratio (F-NLR) score is a novel inflammatory marker constituted by peripheral blood fibrinogen concentration and neutrophil to lymphocyte ratio. In the current study, we aim to explore the relationship between admission F-NLR score and intracerebral hemorrhage (ICH) and assess its prognostic predictive ability in ICH patients. Methods. The original cohort was consecutively recruited from August 2014 to September 2017, and the validation cohort was consecutively recruited between October 2018 and March 2020. The primary outcomes were 3-month functional outcome and 1-month mortality. All statistical analyses were performed using SPSS and R software. Results. A total of 431 and 251 ICH patients were included in original cohort and validation cohort, respectively. In the original cohort, F-NLR score could independently predict the 3-month functional outcome (adjusted OR 2.013, 95% CI 1.316-3.078, p = 0.001 ) and 1-month mortality (adjusted OR 3.036, 95% CI 1.965-4.693, p < 0.001 ). Receiver operation characteristic (ROC) analyses and predictive model comparison indicated that F-NLR score had a stronger predictive ability in the 3-month outcome and 1-month mortality. Validation cohort verified the results. Conclusion. F-NLR score was an independent indicator for both the 3-month functional outcome and 1-month mortality, and its prognostic predictive ability was superior to fibrinogen and NLR in both the original and the validation cohort.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhi-Yong Zeng ◽  
Shao-Dan Feng ◽  
Gong-Ping Chen ◽  
Jiang-Nan Wu

Abstract Background Early identification of patients who are at high risk of poor clinical outcomes is of great importance in saving the lives of patients with novel coronavirus disease 2019 (COVID-19) in the context of limited medical resources. Objective To evaluate the value of the neutrophil to lymphocyte ratio (NLR), calculated at hospital admission and in isolation, for the prediction of the subsequent presence of disease progression and serious clinical outcomes (e.g., shock, death). Methods We designed a prospective cohort study of 352 hospitalized patients with COVID-19 between January 9 and February 26, 2020, in Yichang City, Hubei Province. Patients with an NLR equal to or higher than the cutoff value derived from the receiver operating characteristic curve method were classified as the exposed group. The primary outcome was disease deterioration, defined as an increase of the clinical disease severity classification during hospitalization (e.g., moderate to severe/critical; severe to critical). The secondary outcomes were shock and death during the treatment. Results During the follow-up period, 51 (14.5%) patients’ conditions deteriorated, 15 patients (4.3%) had complicated septic shock, and 15 patients (4.3%) died. The NLR was higher in patients with deterioration than in those without deterioration (median: 5.33 vs. 2.14, P < 0.001), and higher in patients with serious clinical outcomes than in those without serious clinical outcomes (shock vs. no shock: 6.19 vs. 2.25, P < 0.001; death vs. survival: 7.19 vs. 2.25, P < 0.001). The NLR measured at hospital admission had high value in predicting subsequent disease deterioration, shock and death (all the areas under the curve > 0.80). The sensitivity of an NLR ≥ 2.6937 for predicting subsequent disease deterioration, shock and death was 82.0% (95% confidence interval, 69.0 to 91.0), 93.3% (68.0 to 100), and 92.9% (66.0 to 100), and the corresponding negative predictive values were 95.7% (93.0 to 99.2), 99.5% (98.6 to 100) and 99.5% (98.6 to 100), respectively. Conclusions The NLR measured at admission and in isolation can be used to effectively predict the subsequent presence of disease deterioration and serious clinical outcomes in patients with COVID-19.


2021 ◽  
Vol 16 (1) ◽  
pp. 703-710
Author(s):  
Yuhang Mu ◽  
Boqi Hu ◽  
Nan Gao ◽  
Li Pang

Abstract This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups – good and poor – based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10–1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03–1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74–0.824] and 0.714 [95% CI, 0.626–0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hongqiao Zhu ◽  
Lei Zhang ◽  
Taiping Liang ◽  
Yiming Li ◽  
Jian Zhou ◽  
...  

Abstract Background Thoracic aortic endovascular repair (TEVAR) of uncomplicated type B aortic dissection (uTBAD) has favorable long-term outcomes but higher early adverse events compared with the optimal medical treatment. Recently, clinical evidence concerning vascular surgery indicates that elevated preoperative systemic inflammatory response predicts adverse clinical events. The aim of our study was to evaluate the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and early outcomes of uTBAD patients undergoing TEVAR. Results 216 patients diagnosed with uTBAD were included in this retrospective study between January 2015 and December 2018. The median (IQR) follow-up period was 21 (15–33) months. An early adverse event was defined as occurring within 2 years after the procedure. Median patient age was 60 (IQR, 48–68) years and 78.7 % were male. Early adverse events occurred in 24 patients (11.1 %). In the multivariable analysis, preoperative NLR (HR per SD, 1.98; 95 % CI, 1.14–3.44; P = 0.015) was associated with 2-year adverse events. Conclusions NLR is an independent predictive factor of early adverse events in uTBAD patients undergoing TEVAR.


2021 ◽  
Author(s):  
Rajesh Rajan ◽  
Mohammed Al-Jarallah ◽  
Raja Dashti ◽  
Ahmad Al Saber ◽  
Jiazhu Pan ◽  
...  

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