Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker of Functional Outcome in Patients With Intracerebral Hemorrhage (ICH) and Its Comparison With ICH Score: A Hospital-Based Study

Suvarthi Ray; Vijay Kumar; Ratnadeep Biswas; Vishnu S Ojha; Divendu Bhushan; Ravi Kirti; Sanjeev Kumar

doi:10.7759/cureus.69350

Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker of Functional Outcome in Patients With Intracerebral Hemorrhage (ICH) and Its Comparison With ICH Score: A Hospital-Based Study

Cureus. 2024 Sep 13;16(9):e69350. doi: 10.7759/cureus.69350. eCollection 2024 Sep.

Authors

Suvarthi Ray¹, Vijay Kumar¹, Ratnadeep Biswas¹, Vishnu S Ojha¹, Divendu Bhushan², Ravi Kirti¹, Sanjeev Kumar¹

Affiliations

¹ Department of General Medicine, All India Institute of Medical Sciences, Patna, Patna, IND.
² Department of Emergency Medicine, All India Institute of Medical Sciences, Patna, Patna, IND.

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) signifies systemic inflammation, which may correlate with worse outcomes in intracerebral hemorrhage (ICH) patients. This study explored NLR as a prognostic marker of functional outcomes in ICH and compared it with the ICH score.

Methods: This cross-sectional study was conducted at a tertiary-care hospital in India. Blood was collected from patients with ICH to calculate NLR. Functional outcomes were evaluated using the modified Rankin Scale (mRS) at discharge and 90 days follow-up.

Results: The area under receiver operating characteristic curve (AUROC) for NLR predicting poor mRS scores (3-6) at discharge was 0.695 (p = 0.109), and at follow-up, it was 0.729 (p < 0.001) with a cut-off of ≥7.2, sensitivity 68%, and specificity 72%. The AUROC for ICH score was 0.846 (p = 0.003) at discharge and 0.845 (p < 0.001) at follow-up. DeLong's test indicated the ICH score had significantly better predictive performance than NLR at follow-up (p = 0.018).

Conclusions: NLR is a potential prognostic marker for ICH outcomes, showing significant predictive value at 90 days follow-up. However, the ICH score remains a more reliable predictor. Integrating NLR into the ICH score may enhance its prognostic accuracy, but further validation in multicentric studies is needed.

Keywords: functional outcome; intracerebral hemorrhage; intracerebral hemorrhage score; modified rankin scale; neutrophil-to-lymphocyte ratio; prognosis; stroke.