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The association of neutrophil-to-lymphocyte ratio and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage: possible involvement of cerebral blood perfusion

Authors Wu Y, He Q, Wei Y, Zhu J, He Z, Zhang XD, Guo ZD, Xu R, Cheng C, Huang Z, Sun XC

Received 11 October 2018

Accepted for publication 14 February 2019

Published 26 April 2019 Volume 2019:15 Pages 1001—1007

DOI https://doi.org/10.2147/NDT.S190477

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Jun Chen


Yue Wu,1 Qiuguang He,2 Yuling Wei,3 Ji Zhu,1 Zhaohui He,1 Xiaodong Zhang,1 Zongduo Guo,1 Rui Xu,1 Chongjie Cheng,1 Zhijian Huang,1 Xiaochuan Sun1

1Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Neurosurgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Pharmacy, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People’s Republic of China

Background and purpose: Emerging evidence suggests that systemic inflammation is associated with the pathophysiological process of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to investigate the association of white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR) with the occurrence of DCI in SAH patients.
Methods: A total of 122 patients diagnosed with aSAH within 72 h of onset were retrospectively enrolled. The count of WBC, neutrophil count (NC), and lymphocyte (LC) was collected on admission. Computed tomography perfusion was performed within 7 days after SAH. The occurrence of DCI was recorded during the hospitalization.
Results: Among enrolled patients, 43 (35.2%) developed DCI during hospitalization. Patients who developed DCI had a higher count of WBC, NC, and NLR as well as a lower count of LC. NC and NLR were independently associated with the occurrence of DCI, while NLR was the best predictive parameter according to the receiver operating characteristic curve. Moreover, there was a strong correlation between NLR and mean cerebral blood flow, mean transit time and mean time to peak.
Conclusion: Leukocytosis is an early pathology of SAH, and NLR may be a practical predictor for the occurrence of DCI in SAH patients.

Keywords: aneurismal subarachnoid hemorrhage, neutrophil-to-lymphocyte ratio, cerebral blood flow, delayed cerebral ischemia


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