J Korean Neurosurg Soc.  2023 Nov;66(6):681-689. 10.3340/jkns.2023.0157.

Neutrophil to Lymphocyte Ratio and Serum Biomarkers : A Potential Tool for Prediction of Clinically Relevant Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

• Kula O
• Günay B
• Kayabaş MY
• Aktürk Y
• Kula E
• Tütüncüler B
• Süt N
• Solak S

• KMID: 2547462
• DOI: http://doi.org/10.3340/jkns.2023.0157

Abstract

Objective
: Subarachnoid hemorrhage (SAH) is a condition characterized by bleeding in the subarachnoid space, often resulting from the rupture of a cerebral aneurysm. Delayed cerebral ischemia caused by vasospasm is a significant cause of mortality and morbidity in SAH patients, and inflammatory markers such as systemic inflammatory response index (SIRI), systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), and derived NLR (dNLR) have shown potential in predicting clinical vasospasm and outcomes in SAH patients. This article aims to investigate the relationship between inflammatory markers and cerebral vasospasm after aneurysmatic SAH (aSAH) and evaluate the predictive value of various indices, including SIRI, SII, NLR, and dNLR, in predicting clinical vasospasm.
Methods
: A retrospective analysis was performed on a cohort of 96 patients who met the inclusion criteria out of a total of 139 patients admitted Trakya University Hospital with a confirmed diagnosis of aSAH between January 2013 and December 2021. Diagnostic procedures, neurological examinations, and laboratory tests were performed to assess the patients' condition. The Student’s t-test compared age variables, while the chi-square test compared categorical variables between the non-vasospasm (NVS) and vasospasm (VS) groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic accuracy of laboratory parameters, calculating the area under the ROC curve, cut-off values, sensitivity, and specificity. A significance level of p<0.05 was considered statistically significant.
Results
: The study included 96 patients divided into two groups : NVS and VS. Various laboratory parameters, such as NLR, SII, and dNLR, were measured daily for 15 days, and statistically significant differences were found in NLR on 7 days, with specific cut-off values identified for each day. SII showed a significant difference on day 9, while dNLR had significant differences on days 2, 4, and 9. Graphs depicting the values of these markers for each day are provided.
Conclusion
: Neuroinflammatory biomarkers, when used alongside radiology and scoring scales, can aid in predicting prognosis, determining severity and treatment decisions for aSAH, and further studies with larger patient groups are needed to gain more insights.

Keyword

Aneurysmal subarachnoid hemorrhage; Neutrophil-to-lymphocyte ratio; Systemic immune-inflammation index; System inflammation response index; Serum markers; Cerebral vasospasm

Figure

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  Fig. 1. Study flowchart. aSAH : aneurysmatic subarachnoid hemorrhage, WFNS : World Federation of Neurological Surgeons.

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  Fig. 2. Temporal profiles of systemic inflammatory response index (SIRI), systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), and derived NLR (dNLR) plotted during fifteen days following subarachnoid hemorrhage.

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  Fig. 3. Receiver operating characteristic curve analysis in statistically significant days of NLR values. NLR : neutrophil-to-lymphocyte ratio.

Reference

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