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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(06): 515-523
DOI: 10.1055/s-0043-1768662
Original Article

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and prognosis after aneurysmal subarachnoid hemorrhage: a cohort study

Razão neutrófilos-linfócitos e razão plaquetas-linfócitos e o prognóstico de hemorragia subaracnóidea aneurismática: um estudo de coorte
Adilson Jose Manuel de Oliveira 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
2   Clínica Girassol, Divisão de Neurocirurgia, Luanda, Angola.
,
Nicollas Nunes Rabelo 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
João Paulo Mota Telles 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
Davi Jorge Fontoura Solla 
3   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Divisão de Neurologia, São Paulo SP, Brazil.
,
Antonio Carlos Samaia da Silva Coelho 
4   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, São Paulo SP, Brazil.
,
Guilherme Bitencourt Barbosa 
5   Centro Universitário Saúde ABC, Faculdade de Medicina do ABC, Santo André SP, Brazil.
,
Natália Camargo Barbato 
5   Centro Universitário Saúde ABC, Faculdade de Medicina do ABC, Santo André SP, Brazil.
,
Marcia Harumy Yoshikawa 
4   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, São Paulo SP, Brazil.
,
Manoel Jacobsen Teixeira 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
,
Eberval Gadelha Figueiredo 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
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Abstract

Background Subarachnoid hemorrhage (SAH) prognosis remains poor. Vasospasm mechanism might be associated with inflammation. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as inflammation markers and prognostic predictors.

Objective We aimed to investigate NLR and PLR in admission as predictors of angiographic vasospasm and functional outcome at 6 months.

Methods This cohort study included consecutive aneurysmal SAH patients admitted to a tertiary center. Complete blood count was recorded at admission before treatment. White blood cell count, neutrophil count, lymphocyte count, platelet count, NLR, and PLR were collected as independent variables. Vasospasm occurrence-modified Rankin scale (mRS), Glasgow outcome scale (GOS), and Hunt-Hess score at admission and at 6 months were recorded as dependent variables. Multivariable logistic regression models were used to adjust for potential confounding and to assess the independent prognostic value of NLR and PLR at admission.

Results A total of 74.1% of the patients were female, with mean age of 55.6 ± 12.4 years. At admission, the median Hunt-Hess score was 2 (interquartile range [IQR] 1), and the median mFisher was 3 (IQR 1). Microsurgical clipping was the treatment for 66.2% of the patients. Angiographic vasospasm incidence was 16.5%. At 6 months, the median GOS was 4 (IQR 0.75), and the median mRS was 3 (IQR 1.5). Twenty-one patients (15.1%) died. Neutrophil-to-lymphocyte ratio and PLR levels did not differ between favorable and unfavorable (mRS > 2 or GOS < 4) functional outcomes. No variables were significantly associated with angiographic vasospasm.

Conclusion Admission NLR and PLR presented no value for prediction of functional outcome or angiographic vasospasm risk. Further research is needed in this field.

Resumo

Antecedentes O prognóstico da hemorragia subaracnoidea (HSA) permanece ruim. Vasoespasmo pode estar associado à inflamação. Razões neutrófilo-linfócito (NLR) e plaqueta-linfócito (PLR) têm sido estudadas como marcadores de inflamação e prognóstico.

Objetivo Investigar NLR e PLR na admissão como preditores de vasoespasmo angiográfico e desfecho aos 6 meses.

Métodos Este estudo de coorte incluiu pacientes consecutivos com HSA aneurismática de um centro terciário. Contagem de leucócitos, neutrófilos, linfócitos e plaquetas, proporção de neutrófilos para linfócitos e de plaquetas para linfócitos foram coletados como variáveis independentes. Ocorrência de vasoespasmo, escala de Rankin modificada, escala de desfecho de Glasgow e o escore de Hunt-Hess na admissão e 6 meses após a mesma foram registradas como variáveis dependentes. Modelos de regressão logística multivariável foram usados para ajustar potenciais fatores de confusão e avaliar valor prognóstico independente de NLR e PLR.

Resultados Um total de 74,1% pacientes eram do sexo feminino, com idade média de 55,6 ± 12,4 anos. Na admissão, a pontuação média de Hunt-Hess foi de 2 (IQR 1) e a mediana de mFisher foi de 3 (IQR 1). Clipagem microcirúrgica foi o tratamento escolhido para 66,2% dos pacientes. A incidência de vasoespasmo angiográfico foi de 16,5%. Aos 6 meses, a escala de desfecho de Glasgow mediana era 4 (IQR 0,75) e a escala de Rankin modificada mediana era 3 (IQR 1,5). Vinte e um pacientes (15,1%) morreram. Os níveis de NLR e PLR não diferiram entre resultados funcionais favoráveis e desfavoráveis (mRS > 2 ou GOS < 4). Nenhuma variável foi significativamente associada ao vasoespasmo angiográfico.

Conclusão Razão neutrófilo-linfócito e a PLR não apresentaram valor preditivo de desfecho funcional ou risco de vasoespasmo angiográfico. Mais pesquisas são necessárias neste campo.

Keywords

Aneurysm - Neutrophils - Lymphocytes - Platelet Count - Subarachnoid Hemorrhage

Palavras-chave

Aneurisma - Neutrófilos - Linfócitos - Contagem de Plaquetas - Hemorragia Subaracnóidea

Authors' Contributions

AJMO, NNR: conceptualization, methodology, validation, formal analysis, investigation, data curation, writing, supervision, and project administration; JPMT, DJFS, ACSSC, GBB, NCB, MHY, MJT, EGF: conceptualization, methodology, validation, formal analysis, investigation, data curation, and writing.




Publication History

Received: 15 September 2022

Accepted: 17 January 2023

Article published online:
28 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med 2006; 354 (04) 387-396
    Search in Google Scholar
  • 2 Dumont AS, Dumont RJ, Chow MM. et al. Cerebral vasospasm after subarachnoid hemorrhage: putative role of inflammation. Neurosurgery 2003; 53 (01) 123-133 , discussion 133–135
    CrossrefPubMedSearch in Google Scholar
  • 3 Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 1985; 16 (04) 562-572
    CrossrefPubMedSearch in Google Scholar
  • 4 Weir B, Macdonald RL, Stoodley M. Etiology of cerebral vasospasm. In Neurosurgical Management of Aneurysmal Subarachnoid Haemorrhage. 1999. (pp. 27–46). Springer, Vienna.
    CrossrefSearch in Google Scholar
  • 5 Rosenørn J, Eskesen V, Schmidt K. et al. Clinical features and outcome in 1076 patients with ruptured intracranial saccular aneurysms: a prospective consecutive study. Br J Neurosurg 1987; 1 (01) 33-45
    CrossrefPubMedSearch in Google Scholar
  • 6 Feigin VL, Rinkel GJ, Lawes CM. et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005; 36 (12) 2773-2780
    CrossrefPubMedSearch in Google Scholar
  • 7 Suzuki S, Iwabuchi T, Tanaka T. et al. Prevention of cerebral vasospasm with OKY-046 an imidazole derivative and a thromboxane synthetase inhibitor. A preliminary co-operative clinical study. Acta Neurochir (Wien) 1985; 77 (3-4): 133-141
    CrossrefPubMedSearch in Google Scholar
  • 8 Miller BA, Turan N, Chau M, Pradilla G. Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage. BioMed Res Int 2014; 2014: 384342
    CrossrefPubMedSearch in Google Scholar
  • 9 Zheng J, Cai J, Li H. et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as prognostic predictors for hepatocellular carcinoma patients with various treatments: a meta-analysis and review. Cell Physiol Biochem 2017; 44 (03) 967-981
    CrossrefPubMedSearch in Google Scholar
  • 10 Cataudella E, Giraffa CM, Di Marca S. et al. Neutrophil-To-Lymphocyte ratio: An emerging marker predicting prognosis in elderly adults with community- acquired pneumonia. J Am Geriatr Soc 2017; 65 (08) 1796-1801
    CrossrefPubMedSearch in Google Scholar
  • 11 Dong C-H, Wang Z-M, Chen S-Y. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem 2018; 52: 131-136
    CrossrefPubMedSearch in Google Scholar
  • 12 Tao C, Hu X, Wang J, Ma J, Li H, You C. Admission neutrophil count and neutrophil to lymphocyte ratio predict 90-day outcome in intracerebral hemorrhage. Biomarkers Med 2017; 11 (01) 33-42
    CrossrefPubMedSearch in Google Scholar
  • 13 Weng W, Chen X, Gong S, Guo L, Zhang X. Preoperative neutrophil-lymphocyte ratio correlated with glioma grading and glioblastoma survival. Neurol Res 2018; 40 (11) 917-922
    CrossrefPubMedSearch in Google Scholar
  • 14 Mitsuya K, Nakasu Y, Kurakane T, Hayashi N, Harada H, Nozaki K. Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis. J Neurosurg 2017; 127 (02) 433-437
    CrossrefPubMedSearch in Google Scholar
  • 15 Connolly Jr ES, Rabinstein AA, Carhuapoma JR. et al; American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 2012; 43 (06) 1711-1737
    Search in Google Scholar
  • 16 Fang Y-N, Tong M-S, Sung P-H. et al. Higher neutrophil counts and neutrophil-to-lymphocyte ratio predict prognostic outcomes in patients after non-atrial fibrillation-caused ischemic stroke. Biomed J 2017; 40 (03) 154-162
    CrossrefPubMedSearch in Google Scholar
  • 17 Wang J-Y, Zhang X-T, Wang J-Q. et al. Admission Neutrophil-Lymphocyte Ratio Predicts Rebleeding Following Aneurismal Subarachnoid Hemorrhage. World Neurosurg 2020; 138: e317-e322
    CrossrefPubMedSearch in Google Scholar
  • 18 Giede-Jeppe A, Reichl J, Sprügel MI. et al. Neutrophil-to-lymphocyte ratio as an independent predictor for unfavorable functional outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 2019; 132 (02) 400-407
    CrossrefPubMedSearch in Google Scholar
  • 19 Nóbrega Lima Rodrigues de Morais A, Ribeiro Baylão VM, Martins Silva T, Gomes Dos Santos A, Azevedo M. J M de Oliveira A. Is neutrophil-lymphocyte ratio a useful tool for predicting outcome in subarachnoid hemorrhage? A systematic review. Neurosurg Rev 2021; 44 (06) 3023-3028
    CrossrefPubMedSearch in Google Scholar
  • 20 Wu Y, He Q, Wei Y. et al. The association of neutrophil-to-lymphocyte ratio and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage: possible involvement of cerebral blood perfusion. Neuropsychiatr Dis Treat 2019; 15: 1001-1007
    CrossrefPubMedSearch in Google Scholar
  • 21 Aronson JK, Ferner RE. Biomarkers-A General Review. Curr Protocols Pharmacol 2017; 76: 23.1 , 17
    CrossrefPubMedSearch in Google Scholar
  • 22 Califf RM. Biomarker definitions and their applications. Exp Biol Med (Maywood) 2018; 243 (03) 213-221
    CrossrefPubMedSearch in Google Scholar
  • 23 Diem S, Schmid S, Krapf M. et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer 2017; 111: 176-181
    CrossrefPubMedSearch in Google Scholar
  • 24 Aktar F, Tekin R. Mean platelet volume, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in determining the diagnosis or outcome in children with snakebite. Arch Argent Pediatr 2017; 115 (06) 576-580
    CrossrefPubMedSearch in Google Scholar
  • 25 Djordjevic D, Rondovic G, Surbatovic M. et al. Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia?. Mediators Inflamm 2018; 2018: 3758068
    Search in Google Scholar
  • 26 Sabouri E, Majdi A, Jangjui P, Rahigh Aghsan S, Naseri Alavi SA. majdi, A., Jangjui, P., Rahigh-Aghasan, S., & Naseri Alavi, S. A. (2020). Neutrophil-to-lymphocyte ratio and traumatic brain injury: A Review Study. World Neurosurg 2020; 140: 142-147
    CrossrefPubMedSearch in Google Scholar
  • 27 Younan D, Richman J, Zaky A, Pittet J-F. An Increasing Neutrophil-to-Lymphocyte Ratio Trajectory Predicts Organ Failure in Critically-Ill Male Trauma Patients. An Exploratory Study. Healthcare (Basel) 2019; 7 (01) 42
    CrossrefPubMedSearch in Google Scholar
  • 28 Gogoi P, Sinha P, Gupta B, Firmal P, Rajaram S. 2018. Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia. International Journal of Gynecology & Obstetrics.
    CrossrefSearch in Google Scholar
  • 29 Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol 2018; 37 (01) 4-11
    CrossrefPubMedSearch in Google Scholar
  • 30 Mendes BB, Oliveira ACR, Alcântara KC. Comparison of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in normoglycemic and hyperglycemic subjects. Einstein (Sao Paulo) 2019; 17 (01) eAO4403
    CrossrefPubMedSearch in Google Scholar
  • 31 Erre GL, Paliogiannis P, Castagna F. et al. Meta-analysis of neutrophil-to-lymphocyte and platelet-to lymphocyte ratio in rheumatoid arthritis. Eur J Clin Invest 2018
    PubMedSearch in Google Scholar
  • 32 Ida M, Tachiiri Y, Sato M, Kawaguchi M. Neutrophil-to-lymphocyte ratio as indicator to severe complication after pancreaticoduodenectomy or distal pancreatectomy. Acta Anaesthesiol Scand 2019; 63 (06) 739-744
    CrossrefPubMedSearch in Google Scholar
  • 33 Soliman WM, Sherif NM, Ghanima IM. EL-Badawy MA. Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios in Systemic Lupus Erythematosus: Relation With Disease Activity and Lupus Nephritis. Reumatol Clin 2018; •••
    CrossrefPubMedSearch in Google Scholar
  • 34 Qin B, Ma N, Tang Q. et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 2016; 26 (03) 372-376
    CrossrefPubMedSearch in Google Scholar
  • 35 Guan Y, Xiong H, Feng Y, Liao G, Tong T, Pang J. Revealing the prognostic landscape of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in metastatic castration-resistant prostate cancer patients treated with abiraterone or enzalutamide: a meta-analysis. Prostate Cancer Prostatic Dis 2020; 23 (02) 220-231
    CrossrefPubMedSearch in Google Scholar