Research Article| Volume 29, ISSUE 4, 104631, April 2020

Elevated Neutrophil-Lymphocyte Ratio is Predictive of Poor Outcomes Following Aneurysmal Subarachnoid Hemorrhage


      Background Recent studies of patients with intracerebral hemorrhage suggest an association between peripheral blood neutrophil-lymphocyte ratio and neurologic deterioration. We aimed to study the prognostic utility of neutrophil-lymphocyte ratio in predicting inpatient mortality in aneurysmal subarachnoid hemorrhage. Methods We conducted a retrospective electronic medical record review of the clinical, laboratory, and radiographic data of patients with aneurysmal subarachnoid hemorrhage 18 years of age or older presenting to the neuroscience intensive care unit from January 1, 2011, to December 31, 2017. Patients with aneurysmal subarachnoid hemorrhage were divided into 2 groups (group 1, alive at discharge; group 2, deceased prior to discharge), and neutrophil-lymphocyte ratio laboratory mean values were recorded for each patient. Our primary outcome measure was inpatient mortality, and our secondary measure was incidence of pneumonia with hospitalization. Results We identified 403 patients with aneurysmal subarachnoid hemorrhage for the study. After exclusion criteria, 44 eligible patients were divided into the 2 groups (group 1, n = 32; group 2, n = 12). Mean neutrophil-lymphocyte ratio for group 1 was 11.53, and for group 2, 17.85 (P < .01). The mean neutrophil-lymphocyte ratio of those who developed pneumonia compared to those who did not was 15.28 versus 12.81, respectively (P = .39). A Kaplan-Meier plot demonstrated increased mortality among patients with a neutrophil-lymphocyte ratio equal to or greater than 12.5 compared to those with a neutrophil-lymphocyte ratio less than 12.5. Conclusions These preliminary data demonstrate that a neutrophil-lymphocyte ratio equal to or greater than 12.5 at admission predict higher inpatient mortality in patients with aneurysmal subarachnoid hemorrhage.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bhat T
        • Teli S
        • Rijal J
        • et al.
        Neutrophil to lymphocyte ratio and cardiovascular diseases: a review.
        Expert Rev Cardiovasc Ther. 2013; 11: 55-59
        • Zhou Y
        • Wei Q
        • Fan J
        • et al.
        Prognostic role of the neutrophil-to-lymphocyte ratio in pancreatic cancer: a meta-analysis containing 8252 patients.
        Clin Chim Acta. 2018; 479: 181-189
        • Lattanzi S
        • Cagnetti C
        • Provinciali L
        • et al.
        Neutrophil-to-lymphocyte ratio predicts the outcome of acute intracerebral hemorrhage.
        Stroke. 2016; 47: 1654-1657
        • Sun Y
        • You S
        • Zhong C
        • et al.
        Neutrophil to lymphocyte ratio and the hematoma volume and stroke severity in acute intracerebral hemorrhage patients.
        Am J Emerg Med. 2017; 35: 429-433
        • Wang F
        • Hu S
        • Ding Y
        • et al.
        Neutrophil-to-lymphocyteratio and 30-day mortality in patients with acute intracerebral hemorrhage.
        J Stroke Cerebrovasc Dis. 2016; 25: 182-187
        • Naidech AM
        • Drescher J
        • Tamul P
        • et al.
        Acute physiological derangement is associated with early radiographic cerebral infarction after subarachnoid haemorrhage.
        J Neurol Neurosurg Psychiatry. 2006; 77: 1340-1344
        • Bordbar E
        • Paydar S
        • Taghipour M
        • et al.
        Initial GCS and laboratory findings of patients with TBI are associated with the GOSE and mortality rate at one year, a prospective study.
        Ann Neurol. 2016; 80: S234
        • Ogungbo B
        The World Federation of Neurological Surgeons scale for subarachnoid haemorrhage.
        Surg Neurol. 2003; 59 (discussion 7-8): 236-237
        • Guthrie GJ
        • Charles KA
        • Roxburgh CS
        • et al.
        The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer.
        Crit Rev Oncol Hematol. 2013; 88: 218-230
        • Tao C
        • Wang J
        • Hu X
        • et al.
        Clinical value of neutrophil to lymphocyte and platelet to lymphocyte ratio after aneurysmal subarachnoid hemorrhage.
        Neurocrit Care. 2017; 26: 393-401
        • Yilmaz A
        • Ozkul A
        Admission neutrophil to lymphocyte and platelet to lymphocyte ratio as a predictor of mortality in patients with subarachnoid hemorrhage.
        Turkish J Cerebrovasc Dis. 2018; 24: 19-25
        • Sarrafzadeh A
        • Schlenk F
        • Meisel A
        • et al.
        Immunodepression after aneurysmal subarachnoid hemorrhage.
        Stroke. 2011; 42: 53-58