Application of Glasgow Outcome Scale score combined with neutrophil-to-lymphocyte ratio in predicting prognosis of aneurysmal subarachnoid hemorrhage

Abstract

Objective

To determine the independent associations of the Glasgow Outcome Scale (GOS) score and neutrophil-to-lymphocyte ratio (NLR) with aneurysmal subarachnoid hemorrhage (aSAH) prognosis, and evaluate their prognostic value both individually and in combination.

Methods

We conducted a retrospective analysis of 236 aSAH patients admitted within 24 hours of onset. Baseline clinical data included demographics, risk factors, neuroradiological features, treatments, complications, laboratory parameters, and onset-to-sampling interval. Prognosis was assessed using modified Rankin Scale (mRS) scores at 6 months after discharge, with mRS >2 defining poor outcomes. Univariate and multivariate analyses identified independent predictors, and receiver operating characteristic (ROC) curves evaluated predictive performance.

Results

Among 236 patients, 81 (34.3%) had the poor outcome. Multivariate analysis revealed the GOS score [odds ratio (OR)=0.659, 95% confidence interval (CI): 0.145-0.953], NLR (OR=1.218, 95% CI: 1.069-1.796), and delayed cerebral ischemia (OR=2.114, 95% CI: 1.183-3.952) as independent predictors. ROC analysis demonstrated that the AUC for predicting aSAH outcome were 0.669 [the GOS score alone, standard error (SE): 0.036, P<0.001], 0.697 (NLR alone, SE: 0.038, P<0.001), and 0.831 (combined model, SE: 0.029, P<0.001). Z-test comparisons demonstrated that the AUC of the combined model was significantly higher than those of individual predictors (0.831 vs 0.669, Z=3.504, P<0.001; 0.831 vs 0.697, Z=2.803, P<0.01).

Conclusion

Both the GOS score and NLR were independently associated with the prognosis of aSAH patients and could be applied in prognosis assessment. Their combination enhanced predictive value, offering a tool for risk stratification and prognosis assessment.