Association Between Neutrophil-to-Albumin Ratio And Outcome In Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE:The purpose of the present study was to determine if neutrophil-toalbumin ratio(NAR)was associated with disease severity and unfavorable outcome in patients with aneurysmal subarachnoid hemorrhage(aSAH).METHODS: A total of 555 consecutive patients suffering from aSAH were enrolled for the retrospective study.NAR assessments were carried out upon admission,and demographic and clinical parameters recorded simultaneously.The Glasgow Outcome Scale(GOS)score was used to evaluate the functional results at 3 and 12 months,and it was classified into favorable outcome(GOS score 4-5)and unfavorable outcome(GOS score 1-3).The GOS score was used to compare demographic,radiological and laboratory characteristics between aSAH patients with favorable and those with unfavorable outcome at 3 months.Spearman’s correlation coefficient was used to evaluate the correlation between the NAR level and the clinical grade at admission and radiological grade at admission.In addition,a multivariate analysis was performed to evaluate the independent risk factors of poor clinical outcomes.Receiver operator characteristic(ROC)curve analysis identified the best cut-off values for NAR to discriminate between favorable and unfavorable outcome in these patients.To consider the imbalance in baseline characteristics,propensity score matching was performed to assess the effect of NAR on outcome measures.RESULTS: Patients with unfavorable outcomes at 3 months were considerably older,had high amounts of intraventricular and subarachnoidal hemorrhage,exhibited severe clinical conditions at admission,without surgical treatment,with in-hospital complications,such as pneumonia and delayed cerebral ischemia.Based on the GOS score,A significantly higher NLR on admission was observed in patients with unfavorable outcome(GOS 4-5 was: median [IQR] 0.231 [0.177-0.288] vs 0.349[0.264-4.449] for GOS score 1-3;p < 0.001).However,NAR was independently associated with unfavorable outcomes in patients with aSAH after adjusting for potential confounding factors(risk ratio [95% CI] 1.684 [1.338-2.120];p < 0.001).There was a significant correlation between World Federation of Neurosurgical Societies(WFNS)grade at admission and NAR level(r = 0.500,p < 0.001),and there was also a significant correlation between modified Fisher(m Fisher)Scale and NAR level(r = 0.352,p < 0.001).NAR of 0.274 was established as the best cutoff threshold to distinguish between favorable and unfavorable outcomes in ROC analyses(AUC [95% CI] 0.782 [0.740 – 0.823];p < 0.001;GOS 1-3: NAR ≥ 0.274 134/247[54.3%] vs NAR < 0.274 47/308 [15.3%];p < 0.001).Sub-analyses of patients with NAR levels ≥ 0.274 vs < 0.274 were performed using 2 propensity score–matched cohorts(n = 165 patients per group),and the results revealed an increased proportion of patients with unfavorable outcomes and mortality at 3 months in patients with NAR≥0.274(GOS score 1-3 at 3 months: NAR ≥ 0.274 66/165 [40.0%] vs NAR < 0.27432/165 [19.4%];p < 0.001;death at 3 months: NAR ≥ 0.274 32/165 [19.4%] vs NAR< 0.274 15/165 [9.1%];p = 0.007).CONCLUSION: The current study demonstrated the elevated NAR was related to disease severity after aSAH,and NAR represents an independent factor associated with unfavorable outcome in aSAH patients.