摘要
Abstract
Objective To investigate the predictive effect of peripheral blood neutrophil-to-lymphocyte ratio (NLR) on short-term prognosis in primary acute intracerebral hemorrhage at admisson.Methods From December 2015 to December 2017,177 consecutive patients with acute intracerebral hemorrhage admitted to the Department of Neurology,Shengjing Hospital of China Medical University were enrolled retrospectively.According to the modified Rankin scale (mRS) scores,they were divided into either a good prognosis group (mRS ＜ 3,n =109) or a poor prognosis group (mRS ≥ 3,n =68).The clinical data,imaging data,and laboratory data of the patients in both groups were documented.The NLR values were calculated according to neutrophil count and lymphocyte count at admission,and univariate analysis was performed.The factors of P ＜ 0.05 in the results of univariate factor was further performed with multivariate logistic regression analysis of the poor prognosis in patients with acute intracerebral hemorrhage at 90 d.NLR was transformed into binary variable with the median as the cut point and was brought into the model.The receiver operating characteristic (ROC) curve was used to evaluate the sensitivity,specificity,and optimal cut-off value of NLR.Results (1) Compared with the good prognosis group,the poor prognosis group had higher NIHSS score (11 [8,16] vs.3 [2,5]) and lower GCS score (13 [6,15] vs.15 [15,15]).There were statistical differences between the two groups (all P ＜ 0.01).(2) Compared with the good prognosis group,the proportion of surgical treatment was higher in patients in the poor prognosis group.There was significant difference between the two groups (39.7％ [27/68] vs.14.7％ [16/109],P ＜ 0.0l).There were no significant differences in the other baseline data between the two groups (all P ＞0.05).(3) Compared with the good prognosis group,the poor prognosis group had higher NLR value (8.92 [4.83,16.07] vs.3.45 [2.22,5.81]) and blood glucose levels (7.36[6.19,9.25] mmol/L vs.6.33[5.27,8.18] mmol/L) at admission,the differences were statistically significant between the two groups (all P ＜0.01);There was no significant difference in creatinine levels between the two groups (P ＞ 0.05).(4) Compared with the good prognosis group,the poor prognosis group had larger hematoma volume (38.64 [16.89,77.14] ml vs.9.69[2.64,19.12] ml),higher proportion of ruptured into ventricles (60.3％ [41/68] vs.22.0％ [24/109].There were statistical differences between the two groups (all P ＜ 0.01);there was no statistically significant difference in location of cerebral hemorrhage between the two groups (P ＞ 0.05).(5) The results of multivariate logistic regression analysis showed that NLR ≥ 5.00 (OR,4.718,95％ CI 1.770-12.572),increased hematoma volume (OR,1.046,95％ CI 1.016-1.077) and higher NIHSS score (OR,1.411,95％CI 1.242-1.602) were the independent risk factors for poor prognosis at 90 d after discharge in patients with acute intracerebral hemorrhage (all P ＜ 0.01),and surgical treatment (OR,0.126,95％ CI 0.026-0.608) were the protective factors for the prognosis of acute intracerebral hemorrhage (P ＜ 0.01).(6) The area under curve of NLR was 0.779 (95％ CI0.710-0.847,P ＜0.01).When the cut-off value of NLR was 5.63,the maximum Youden index was 0.464,and its sensitivity was 72.1％ and specificity was 74.3％.Conclusions High NLR may indicate poor short-term prognosis in acute intracerebral hemorrhage.When NLR ＞ 5.63 is used as a screening index for poor prognosis of acute intracerebral hemorrhage,a comprehensive and objective assessment is needed.关键词
脑出血/中性粒细胞与淋巴细胞比值/预后Key words
Cerebral hemorrhage/Neutrophil-to-lymphocyte ratio/Prognosis
