Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker of Functional Outcome in Patients With Intracerebral Hemorrhage (ICH) and Its Comparison With ICH Score: A Hospital-Based Study

 

So you documented a problem, WHAT THE FUCK IS THE SOLUTION TO PREVENT IT? My directors would never let me get away with describing a problem without having a possible solution in hand. I'd be fired in no time.

Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker of Functional Outcome in Patients With Intracerebral Hemorrhage (ICH) and Its Comparison With ICH Score: A Hospital-Based Study

Suvarthi Ray • Vijay Kumar • Ratnadeep Biswas • Vishnu S. Ojha • Divendu Bhushan • Ravi Kirti • Sanjeev Kumar

Published: September 13, 2024

DOI: 10.7759/cureus.69350 

  Peer-Reviewed

Cite this article as: Ray S, Kumar V, Biswas R, et al. (September 13, 2024) Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker of Functional Outcome in Patients With Intracerebral Hemorrhage (ICH) and Its Comparison With ICH Score: A Hospital-Based Study. Cureus 16(9): e69350. doi:10.7759/cureus.69350

• Article
• Authors etc.
• Metrics
• Media
• Comments

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) signifies systemic inflammation, which may correlate with worse outcomes in intracerebral hemorrhage (ICH) patients. This study explored NLR as a prognostic marker of functional outcomes in ICH and compared it with the ICH score.

Methods: This cross-sectional study was conducted at a tertiary-care hospital in India. Blood was collected from patients with ICH to calculate NLR. Functional outcomes were evaluated using the modified Rankin Scale (mRS) at discharge and 90 days follow-up.

Results: The area under receiver operating characteristic curve (AUROC) for NLR predicting poor mRS scores (3-6) at discharge was 0.695 (p = 0.109), and at follow-up, it was 0.729 (p < 0.001) with a cut-off of ≥7.2, sensitivity 68%, and specificity 72%. The AUROC for ICH score was 0.846 (p = 0.003) at discharge and 0.845 (p < 0.001) at follow-up. DeLong's test indicated the ICH score had significantly better predictive performance than NLR at follow-up (p = 0.018).

Conclusions: NLR is a potential prognostic marker for ICH outcomes, showing significant predictive value at 90 days follow-up. However, the ICH score remains a more reliable predictor. Integrating NLR into the ICH score may enhance its prognostic accuracy, but further validation in multicentric studies is needed.

Introduction

Stroke is one of the leading causes of disability globally and stands as the second most common cause of death worldwide. According to the Global Stroke Factsheet, the lifetime risk of experiencing a stroke has increased by 50% over the past 17 years, and current estimates indicate that one in four people will suffer a stroke during their lifetime [1]. Despite advances in management, the burden of stroke is increasing every year with an increase in morbidity and mortality, disproportionately affecting the lower and lower-middle-income countries [2,3].

Intracerebral hemorrhage (ICH) constitutes 10-15% of all initial strokes, with an incidence of approximately 29.9 per 100,000 person-years, and is associated with higher mortality and more severe disabilities than other stroke types [4,5]. Hemorrhagic stroke occurs when a blood vessel in the brain ruptures, causing bleeding within the brain tissue. ICH occurs most commonly due to long-standing hypertension, but other causes, such as head trauma and pre-existing lesions, such as vascular malformations or tumors, are often encountered as well [6].

Despite recent improvements in medical intensive care, the mortality and morbidity rates for ICH in intensive care units remain high. ICH carries a significant risk of death, with up to 54% of patients dying within a year [7]. Even among survivors, only a small proportion (12-39%) regain full independence [8]. Thus, the search for more efficient screening modalities and better optimization of management for ICH cases is always going on.

The neutrophil-to-lymphocyte ratio (NLR) is a simple calculation derived from routine blood tests that reflects the balance between inflammation and immune regulation. Higher NLR values have been linked to worse outcomes in various diseases, including heart disease, cancer, and infections [9]. Recent studies have highlighted its prognostic value in predicting outcomes in patients with various conditions, such as COVID-19, rheumatoid arthritis, and cancers like gastric cancer, underscoring its utility in both acute and chronic disease management [10-12].

Some studies have recognized NLR as a potential prognostic marker for ICH, reflecting the inflammatory response associated with this condition. Elevated NLR levels have been linked to worse outcomes in ICH patients, including higher mortality and greater disability [13]. However, research on NLR as a prognostic tool for ICH is still in its early stages, with few studies published, particularly in developing countries like India, where stroke incidence is high and healthcare resources are often limited [14]. More extensive studies are needed in these settings to validate the reliability and utility of NLR in predicting the prognosis of ICH patients and to explore its potential role in guiding treatment strategies.

This study aimed to evaluate whether NLR could serve as an independent predictor of patient functional outcomes after intracerebral hemorrhage, in comparison to the standard ICH score.