The Effect of Neutrophil-Lymphocyte Ratio on Prognosis in Acute Hemorrhagic Stroke: A Retrospective Study

Objective: The study aim is to evaluate the relationship of short-term mortality with the neutrophil to lymphocyte ratio (NLR) in acute hemorrhagic stroke. Method: The retrospective study included 106 patients who admitted within 24 hours of AHS. A hemogram (peripheral venous blood sample) was taken at admission. The ratio of neutrophils to lymphocytes was calculated. Thirty days was defined as duration of follow-up. A mortality and survival groups were detected within 30 days. Results: During the follow-up period, twenty-eight of 106 patients died. The median NLR was significantly higher in the mortality group compared then the survival group (8.87; IQR 10.8 vs . 5.12; IQR 5.3, respectively; p=0.021) as well as a blood glucose level and hematoma volume. In the Cox regression model, NLR was not an independent variable as short-term mortality predictors. The specificity for short-term mortality when the NLR (>7.54) was 71.8%, and the sensitivity was 60.7%. The positive predictive value of a NLR (>7.5) was 43.6%, negative predictive value was 83.6% [Area under the ROC curve, 0.647; 95% CI, 0.548-0.738]. A weak linear positive correlations were found between NLR and National Institutes of Health Stroke Scale (NIHSS), and negative correlation between NLR and Glaskow Coma Score (GCS) (r=0.281; p=0.004, r=-0.283; p=0.002, respectively). Conclusions: The NLR at admission is significantly higher in mortality group than survival group, but it has lower sensitivity and specificity for short-term mortality than acute ischemic stroke. NLR may be important to follow short-term mortality, but it can be affected by dependents variables such as hematoma volume.