Prognostic Significance Of Neutrophil-to-lymphocyte Ratio In Patients With Spontaneous Basal Ganglia Hemorrhage

Objective:Increasing evidence showed that stroke-related immune-inflammatory response plays an important role in secondary brain injury after stroke.The identification of specific inflammatory markers in peripheral blood may be an objective indicator to evaluate the clinical prognosis of stroke patients.Among them,neutrophil-to-lymphocyte ratio(NLR)has been proved to be an independent predictor of poor prognosis in patients with ischemic stroke and traumatic brain injury.However,the association between NLR and outcome in patients with intracerebral hemorrhage is insufficiently established.This study aimed to evaluate the prognostic significance of admission NLR in patients with spontaneous basal ganglia hemorrhage(SBGH).Methods:The clinical data of all SBGH patients hospitalized in the First Affiliated Hospital of Nanchang University from June 2018 to June 2021 were retrospectively collected.Functional outcome was assessed at 30 days after admission using the Glasgow Outcome Scale(GOS)score and categorized into favorable(GOS score 4-5)and unfavorable outcome(GOS score 1-3).Logistic regression analyses was used to investigate parameters associated with unfavorable outcome.Receiver operating characteristic(ROC)curve analysis was undertaken to identify the best cutoff for NLR to discriminate between favorable and unfavorable outcome.To adjust for potential imbalances in the clinical parameters,propensity score matching(PSM)was conducted to assess the influence of NLR on outcome measures.According to the results of multivariate analysis,predictive models were constructed and the Akaike information criterion(AIC)and consistency index(C-index)were used to evaluate the predictive accuracy of NLR and its clinical value.Finally,the risk of poor prognosis was visualized using normogram.Results:A total of 252 patients with SBGH were included.The incidence of unfavorable outcome at 30 days was 58.7%(148/252).In univariate analysis,patients with unfavorable outcome were older,had worse neurological status on admission(Glasgow Coma Scale score [GCS] and Intracerebral Hemorrhage score),higher admission systolic blood pressure and blood glucose level,larger hematoma volumes,a greater amount of intraventricular hemorrhage(Graeb score),higher rates of pneumonia and tracheotomy,more patients underwent surgical intervention,and more frequently presenting with hydrocephalus and abnormality of pupils on admission(p< 0.05).A significantly higher NLR on admission was observed in patients with unfavorable functional outcome at 30 days(median [IQR]: 17.17 [11.85-24.74] vs5.44 [3.59-8.26];p < 0.001).Multivariate Logistic regression analysis showed that NLR remained a significant predictor for unfavorable outcome in SBGH patients(OR[95% CI]: 1.148 [1.047-1.260];p = 0.003).In addition,GCS score,hematoma volume,pneumonia,and treatment modality were also identified as independent predictors of poor outcomes(p < 0.05).In ROC analysis,an NLR of 9.02 was identified as the best cutoff value to discriminate between favorable and unfavorable outcome(area under the curve = 0.893,Youden’s index = 0.673,p < 0.001).Subanalysis of patients with NLR levels ≥ 9.02 vs < 9.02,performed using 2propensity score-matched cohorts(n = 53 patients in each group),revealed an increased proportion of patients with unfavorable functional outcome at 30 days in patients with NLR ≥ 9.02(NLR ≥ 9.02: 43/53 [81.1%] vs NLR < 9.02: 26/53 [49.1%];p = 0.001);a significant difference in mortality between the two subgroups was also observed(NLR ≥ 9.02: 17/53 [32.1%] vs NLR < 9.02: 8/53 [15.1%];p = 0.039);and patients with higher NLR are more likely to develop pneumonia during hospitalization(NLR ≥ 9.02,31/53 [58.5%] vs NLR < 9.02,19/53 [35.8%];p =0.020).Comparing with the basic model(GCS score,hematoma volumes,pneumonia,treatment modality),the basic model with NLR had higher C-index and lower AIC,indicating the better predictive accuracy and model-fitting.The nomogram showed a good discrimination ability,with a C-index of 0.974.Conclusion:Among SBGH patients,NLR represents an independent parameter associated with unfavorable functional outcome.NLR ≥ 9.02 was the best prediction threshold for poor prognosis at 30 days.Combining NLR with GCS scores,pneumonia and treatment modality improved the accuracy of prognosis prediction.High NLR levels were also associated with the incidence of pulmonary infection in SBGH patients during hospitalization.