Correlation Between Inflammatory Markers Such As Neutrophil To Albumin Ratio And 90 Day Prognosis Of Hypertensive Intracerebral Hemorrhage Patients

Background: Hypertensive Intracerebral Hemorrhage(HICH)is a common spontaneous cerebrovascular disease caused by damage to cerebral arteries,veins,or capillaries,especially in hypertensive patients.However,most patients have poor prognosis due to the rapid progression of the disease and the lack of outcome prediction indicators.Objective: according to the neutrophil to albumin ratio(NAR)as an inflammatory composite indicator,the study aims to explore whether inflammatory markers such as NAR can guide the treatment for hypertensive intracerebral hemorrhage in clinic by analyzing the correlation with prognosis in HICH,so as to improve prognosis.Method: A total of 252 HICH patients were included retrospectively in the study,who visited our neurology department from January 2020 to September 2022.Their baseline data were collected,such as age,gender,location of cerebral hemorrhage,volume of cerebral hemorrhage,the condition of broken ventricle,blood pressure,history of diabetes and hyperlipidemia at admission;as well as the detection on neutrophil count,albumin level and NAR,neutrophil to lymphocyte ratio(NLR),and lymphocyte monocyte ratio(LMR).They were divided into three groups according to the volume of cerebral hemorrhage,including slight cerebral hemorrhage group(less than 10ml),moderate cerebral hemorrhage group(10-30ml),and severe cerebral hemorrhage group(more than 30ml).In addition,HICH patients were split into three groups in terms of the severity following evaluated using the Glasgow Coma Scale,such as mild group(GCS: 13-15 points),moderate group(GCS: 9-12 points),and severe group(GCS:<9 points).Then,they were grouped based on the neurological function recovery status of patients 90 days after onset with the Modified Ranks Score(MRS),containing good prognosis group(MRS: 0-3 points)and poor prognosis group (MRS: 4-6 points).Moreover,the correlation between NAR and the severity of cerebral hemorrhage(GCS score)and hematoma volume were analyzed according to Spearman correlation.The above three type groups were compared the baseline differences among the severity of HICH,cerebral hemorrhage volume,and good poor prognosis groups using single factor analysis.The independent risk factors for severity(represented by GCS score)and hematoma volume in HICH patients were analyzed using multiple logistic regression.Finally,the independent risk factors for poor prognosis were identified by using multivariate binary logistic regression analysis,as well as the predictive value of NAR for poor prognosis in HICH patients combined with receiver operating characteristic curve(ROC).Result: the 252 HICH patients contained 140 in the mild group,75 in the moderate group,and 37 in the severe group;There were 185 cases in slight cerebral hemorrhage group,27 cases in moderate cerebral hemorrhage group,and 40 cases in severe cerebral hemorrhage group;185 cases in good prognosis and 67 cases in poor prognosis.1.Correlation analysis of NAR with cerebral hemorrhage volume and severity in patients with HICH:NAR was positively correlated with the volume of cerebral hemorrhage at admission(r=0.18,p<0.001),with a negative correlation between NAR and admission GCS score(r=-0.27,P<0.001).2.Association of NAR with severity of cerebral hemorrhage(1)There were statistical differences among the slight,moderate,and severe cerebral hemorrhage groups in terms of cerebral hemorrhage volume,the condition of broken ventricle,diastolic blood pressure,age,NAR,and NLR(P<0.05),while other indicators were not statistically significant,according to univariate analysis.(2)Multivariate ordered multiple logistic regression analysis hinted that cerebral hemorrhage volume,NAR,and NLR were independent risk factors for the severity of HICH patients,with p-values less than 0.05 and statistically significant.3.Correlation between NAR and intracerebral hemorrhage volume(1)There were statistical differences among the slight,moderate,and severe cerebral hemorrhage groups in terms of GCS scores,the condition of broken ventricle,NAR,and NLR(p<0.05),while other indicators were not statistically significant,according to univariate analysis.(2)Multivariate ordered multiple logistic regression analysis suggested that GCS score and the condition of broken ventricle were independent risk factors for cerebral hemorrhage volume in HICH patients,with p-values less than 0.05 and statistically significant.4.Correlation between NAR and poor prognosis in patients with HICH(1)There were statistical differences between the good prognosis group and the poor prognosis group in terms of GCS scores,the condition of broken ventricle,NAR,NLR and LMR(p<0.05),while other indicators were not statistically significant,according to univariate analysis.(2)Binary logistic regression analysis indicated cerebral hemorrhage volume,GCS score,NAR,and NLR were independent risk factors for 90-day poor prognosis in HICH patients,with p-values less than 0.05 and statistically significant.(3)The area under the curve(AUC)of cerebral hemorrhage volume,GCS score,NAR,and NLR were 0.81,0.80,0.68,and 0.63,respectively,according to ROC curve analysis,with statistical differences(p<0.01),indicating good prediction.Conclusions:(1)High levels of NAR and NLR are independent risk factors for high severity in HICH patients.(2)High levels of NAR and NLR are independent risk factors for poor 90 day prognosis in HICH patients.(3)High levels of NAR and NLR can predict 90-day poor prognosis in HICH patients.