title: Clinical Value of Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratio After Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Inflammation and thrombosis are associated with the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are emerging as novel inflammatory markers in stroke. We aimed to identify the association of NLR and PLR with delayed cerebral ischemia (DCI) and 3-month outcome after aSAH.
  
  
  METHODS
  Two hundred and forty-seven patients diagnosed with aSAH within 24 h of symptoms onset were enrolled. Clinical, neuroradiological, laboratory, and follow-up data were collected from electronic database. Functional outcome was assessed by modified Rankin Scale. Admission NLR, PLR, and combined NLR-PLR associated with outcomes were evaluated by logistic regression analysis, and we used receiver operating characteristic curves to detect the overall predictive accuracy of these markers.
  
  
  RESULTS
  Fifty-five (22.3 %) patients had unfavorable outcome and 47 (19 %) developed DCI. Both NLR and PLR were correlated with WFNS grade (ρ = 0.35[p < 0.001], ρ = 0.28[p < 0.001]) and modified Fisher grade (ρ = 0.25[p = 0.001], ρ = 0.28[p = 0.003]) and independently related to DCI (OR 2.18, 95 %CI 1.51-3.15, p = 0.016; OR 2.21, 95 %CI 1.61-3.32, p = 0.008) and functional outcome (OR 1.89, 95 %CI 1.52-3.17, p = 0.015; OR 1.77, 95 %CI 1.48-3.21, p = 0.018) at 3 months after aneurysm repair. They had comparable predictive ability in DCI occurrence (area under the curve [AUC] 0.65, 95 %CI 0.55-0.74, p = 0.002; AUC 0.68, 95 %CI 0.60-0.76, p < 0.001) and poor outcome (AUC 0.70, 95 %CI 0.63-0.77, p < 0.001; AUC 0.65, 95 %CI 0.58-0.72, p = 0.001). However, combination of the two indexes showed a better predictive value than each alone (AUC 0.73, 95 %CI 0.66-0.81, p < 0.001 for DCI; AUC 0.76, 95 %CI 0.70-0.83, p < 0.001 for poor outcome).
  
  
  CONCLUSIONS
  NLR and PLR as novel inflammatory biomarkers are independent predictors of DCI development and functional outcome after acute aSAH. When combined together, they may help to identify high-risk patients more powerfully.
authors.affiliation: Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Chuanyuan
authors.initials: C
authors.lastname: Tao
authors.affiliation: Department of Critical Care Medicine, Neurosurgical Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Jiajing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Hu
authors.affiliation: Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Junpeng
authors.initials: J
authors.lastname: Ma
authors.affiliation: Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China. tcy106@163.com.
authors.forename: Chao
authors.initials: C
authors.lastname: You
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001772:Blood Cell Count; D001792:Blood Platelets; D002545:Brain Ischemia / Q000097:blood* / Q000209:etiology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000209:etiology
chemical_list: D015415:Biomarkers
keywords: Aneurysmal subarachnoid hemorrhage; Delayed cerebral ischemia; Neutrophil to lymphocyte ratio; Outcome; Platelet to lymphocyte ratio