Neutrophil-to-lymphocyte ratio improves outcome prediction of acute intracerebral hemorrhage

Background: The inflammatory response plays a role in determining the course of intra-cerebral hemorrhage (ICH) and immune parameters may have prognostic value. The aim of the study was to determine whether the peripheral leukocyte counts and neutrophil-to-lymphocyte ratio (NLR) were associated to 30-day functional status after ICH, and improved the accuracy of outcome prediction when added to the Modified ICH score. Methods: We retrospectively identified consecutive patients with spontaneous ICH who underwent blood sampling and cranial CT neuroimaging within 24 h from onset. Total white blood cells (WBC), absolute neutrophil count (ANC) and absolute lymphocyte count (ALC) were collected, and the NLR computed as the ANC to ALC ratio. The study endpoint was 30-day functional status; poor outcome was defined as death or major disability (modified Rankin Scale score ≥ 3). Results: Two hundred and eight patients were enrolled, of which 111 (53.4%) had a modified Rankin Scale score ≥ 3 at 30 days from ICH. At multivariate analysis, the WBC (adjusted odd ratio [adjOR] for 1000 leukocytes increase 1.20, 95% confidence interval [CI] 1.05–1.38), ANC (adjOR for 1000 neutrophils increase 1.34, 95% CI 1.14–1.57), ALC (adjOR for 1000 lymphocytes increase 0.34, 95% CI 0.20–0.59) and NLR (adjOR for 1-point increase 1.49, 95% CI 1.24–1.79) were independently associated with 30-day poor outcome. Predictive accuracy of the Modified ICH score was enhanced by adding the NLR. Conclusions: The NLR was associated with 30-day mortality and morbidity after ICH, and improved the accuracy of outcome prediction when added to the Modified ICH score.