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Abstract Details

Temporal profile of Neutrophil-to-lymphocyte ratio predicts Subarachnoid Hemorrhage Outcomes
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
099
We hypothesize that elevated NLR over time during acute SAH may be associated with short term outcome. 

Emerging evidence suggests systemic inflammation worsens ischemic stroke and hemorrhagic stroke outcomes.  While neutrophil- to-lymphocyte ratio (NLR), a marker of systemic inflammation, may be associated with subarachnoid hemorrhage (SAH) outcome when measured on hospital admission, there is little data on how NLR over time may impact SAH outcome.

Consecutive adult patients presenting within 96 hours of spontaneous SAH admitted to a single academic center between January 1, 2017 to January 1, 2020 were included. Investigators determined time of SAH onset, SAH clinical (Hunt and Hess) and radiographic severity scores (modified Fischer), angiographic vasospasm, delayed cerebral ischemia, and functional outcome measured by modified Rankin Score (mRS) at hospital discharge. Temporal profiles of neutrophil and lymphocyte counts and NLR on post-SAH onset days 1 – 10 were compared between favorable (mRS < 3) and unfavorable (mRS >=3) outcome groups. We use  linear mixed effect model with repeated measures to determine whether NLR temporal profiles were independently associated with SAH outcome.
 Total cohort has 229 patients with a mean age of 59 years and 71% female.  NLR from post-SAH day 0-10 is elevated patients with unfavorable outcome.  Between-group difference remained statistically significant after adjusting for age and clinical severity score  (p<0.0001).  There is no interaction between outcome groups over time (p=0.38).  Absolute neutrophil and lymphocyte count over time showed no between-group difference (p=0.055 & p=0.68, respectively).
Elevation in peripheral blood NLR over time during acute SAH is strongly associated with unfavorable short-term outcome at hospital discharge after adjusting for age and SAH clinical severity grade effects.  Future studies are needed to validate this finding and to investigate potential mechanisms action of NLR and systemic inflammation on SAH outcome. 
Authors/Disclosures
Charith Ratnayake
PRESENTER 		Mr. Ratnayake has nothing to disclose.
No disclosure on file
Aditya Sharma Mr. Sharma has nothing to disclose.
Carlos Villamizar Rosales, MD (UPMC) Dr. Villamizar Rosales has nothing to disclose.
No disclosure on file
No disclosure on file
Bradley Molyneaux, MD, PhD (Brigham and Women's Hospital) Dr. Molyneaux has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Molyneaux has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Billing, Cochran, Lyles, Mauro and Ramsey. The institution of Dr. Molyneaux has received research support from NIH. Dr. Molyneaux has received publishing royalties from a publication relating to health care.
No disclosure on file
Sherry Hsiang-Yi Chou, MD (Departmnt of Neurology, Northwestern Feinberg School of Medicine) Dr. Hsiang-Yi Chou has received personal compensation for serving as an employee of NIH. An immediate family member of Dr. Hsiang-Yi Chou has received personal compensation for serving as an employee of Wells Fargo. Dr. Hsiang-Yi Chou has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Grace Therapeutics. The institution of Dr. Hsiang-Yi Chou has received research support from The Neurocritical Care Society. Dr. Hsiang-Yi Chou has a non-compensated relationship as a Board of Director member with United Council of Neurologic Specialties that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Hsiang-Yi Chou has a non-compensated relationship as a Co-chair/chair-elect, the Neurocritical Care Committee with American Heart Association, the Stroke Council that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Hsiang-Yi Chou has a non-compensated relationship as a Co-chair/chair ellect, the Neurocritical Care Special Interest Group with American Neurologic Association that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.