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Is neutrophil-lymphocyte ratio a useful tool for predicting outcome in subarachnoid hemorrhage? A systematic review

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Abstract

Ruptured intracranial aneurysms, as the leading cause of spontaneous subarachnoid hemorrhage (aSAH), represents an emergency with high morbi-mortality. The comprehension of the underlying pathology that involves inflammatory and immune responses, through the neutrophil-to-lymphocyte ratio (NLR), could help to predict complications such as delayed cerebral ischemia (DCI) or rebleeding and the functional outcome. Systematic review of English-based literature through PubMed and Biblioteca Vitural em Saúde (BVS) to find papers discussing the use of NLR in the aSAH setting. Area-under-curve (AUC) of receiver operating characteristics (ROC), cutoff value, sensitivity, and specificity were retrieved. From 53 articles included, 4 papers were evaluated after exclusion criteria. Rebleeding could be predicted with a NLR cutoff value of 9.88 (sensitivity 72.3%, specificity 63.3%). The mean cutoff value for DCI was 12.85, with sensitivity 66.3% and specificity 75.8%. Finally, a worse 3-month functional outcome could be predicted with a mean sensitivity of 73.3% and a mean specificity of 54%. NLR is a new issue in scientific community, especially neurosurgery. The current understanding points to a multifactorial process after aSAH that emerges as alterations on the NLR. As a measurement readily available and cost-effect after admission of the patient, its use signals that patients that need expedite surgical treatment or more aggressive treatment for vasospasm. As other medical subspecialties already use this ratio to predict outcomes, the literature reviewed by this paper constitute the earliest clues that higher NLR predicts re-bleeding, DCI, and functional outcome.

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Authors and Affiliations

  1. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, PO Box: 02010-000, R. Voluntários da Pátria, 764, São Paulo, Brazil

    Artur Nóbrega Lima Rodrigues de Morais & Adilson J. M. de Oliveira

  2. Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Victor Matheus Ribeiro Baylão, Tamires Martins Silva & Alexandra Gomes dos Santos

  3. Faculdade de Ciências da Universidade Federal do ABC, São Bernardo do Campo, Brazil

    Mayara Azevedo

  4. Neurosurgery department, Clínica Girassol, Luanda, Angola

    Adilson J. M. de Oliveira

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  1. Artur Nóbrega Lima Rodrigues de Morais
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Contributions

All authors contributed to the study conception and design. Material preparation and data analysis were performed by Artur Nobrega Lima Rodrigues de Morais. Data collection was performed by Artur Nobrega Lima Rodrigues de Morais and Victor Matheus Ribeiro Baylão. The first draft of the manuscript was written by Artur Nobrega Lima Rodrigues de Morais, Adilson JM. de Oliveira, and Victor Matheus Ribeiro Baylão. Artur Nobrega Lima Rodrigues de Morais, Victor Matheus Ribeiro Baylão, Alexandra Gomes dos Santos, Mayara Azevedo, Tamires Martins, and Adilson JM. de Oliveira critically revised the work. All authors read and approved the final manuscript.

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Correspondence to Artur Nóbrega Lima Rodrigues de Morais.

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Nóbrega Lima Rodrigues de Morais, A., Ribeiro Baylão, V.M., Martins Silva, T. et al. Is neutrophil-lymphocyte ratio a useful tool for predicting outcome in subarachnoid hemorrhage? A systematic review. Neurosurg Rev 44, 3023–3028 (2021). https://doi.org/10.1007/s10143-021-01484-7

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