title: Neutrophil to lymphocyte ratio and the hematoma volume and stroke severity in acute intracerebral hemorrhage patients.
abstract: BACKGROUND
  Neutrophil to lymphocyte ratio (NLR) serves as a powerful inflammatory marker for predicting cardiovascular events. Here, we investigate whether admission NLR is associated with hematoma volume, stroke severity, and 3-month outcomes in patients with acute intracerebral hemorrhage (ICH).
  
  
  METHODS
  352 patients with acute ICH were prospectively identified in this study. Demographic characteristics, lifestyle risk factors, NIHSS score, hematoma volumes, and other clinical features were recorded for all participants. Patients was divided into quartiles based on the admission NLR levels (Q1: <2.78; Q2: 2.78-4.08; Q3: 4.08-7.85; Q4: ≥7.85). Multivariable linear regression models and logistic regression models were used to evaluate the association between NLR and hematoma volume, admission severity, or the outcomes after ICH.
  
  
  RESULTS
  Median NIHSS scores for each quartile (Q1 to Q4) were 6.0, 6.0, 6.0, and 11.0 (P=.001), and median hematoma volumes were 9.5, 9.3, 9.1, and 15.0ml (P=.005), respectively. After adjusting the age, sex, and other potential risk factors, the patients in Q4 had higher NIHSS scores (P=.042) and larger hematoma volume (P=.014). After 3-month follow-up, 148 poor outcomes (mRS, 3-6) and 47 all-cause deaths were documented. There were more patients with poor outcomes in Q4 than Q1. However, compared with the patients in Q1, those in Q4 were not associated with poor outcomes (P-trend=0.379), and all-cause mortality (P-trend=0.843) after adjust for other risk factors.
  
  
  CONCLUSIONS
  Higher admission NLR are associated with larger hematoma volume and more serious stroke, but not 3-month outcomes in patients with acute ICH.
authors.affiliation: Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Department of Neurology, Zhangjiagang Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Suzhou 215600, China.
authors.forename: Yaming
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
authors.forename: Shoujiang
authors.initials: S
authors.lastname: You
authors.affiliation: Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China.
authors.forename: Chongke
authors.initials: C
authors.lastname: Zhong
authors.affiliation: Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
authors.forename: Zhichao
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Institutes of Neuroscience, Soochow University, Suzhou 215123, China.
authors.forename: Lifang
authors.initials: L
authors.lastname: Hu
authors.affiliation: Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
authors.forename: Jijun
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institutes of Neuroscience, Soochow University, Suzhou 215123, China. Electronic address: yongjuncao@126.com.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institutes of Neuroscience, Soochow University, Suzhou 215123, China. Electronic address: liuchunfeng@suda.edu.cn.
authors.forename: Chun-Feng
authors.initials: CF
authors.lastname: Liu
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001810:Blood Volume; D002543:Cerebral Hemorrhage / Q000150:complications*; D005260:Female; D006406:Hematoma / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000209:etiology*
chemical_list: D015415:Biomarkers
keywords: Hematoma volume; Intracranial hemorrhage; Neutrophil to lymphocyte ratio; Stroke severity