| BackgroundSpontaneous intracerebral hematoma(sICH)is described as non traumatic bleeding into the brain parenchyma with abrupt onset of severe headache,altered level of consciousness,and/or focal neurologic deficit.It is reported that the 30-day mortality rate of sICH is as high as 40-50%,and remains without a treatment of proven benefit,which has always been one of the heavy burdens of society and family.A growing body of evidence has indicated that the inflammatory immune response plays a major role in secondary brain injury,however,the predictive value of related inflammatory markers for the prognosis of ICH remains controversial.Lymphocyte-to-monocyte ratio(LMR)is a comprehensive indicator of inflammation,which can evaluate the dynamic changes of lymphocytes and monocytes in a balanced manner.The systemic immune inflammation index(SII)includes platelet counts in addition to lymphocytes and monocytes.Under physiological conditions,the content of lymphocytes in the brain is very low.After 24 hours of pathological injury caused by ICH,lymphocytes begin to increase.Activated lymphocytes can cross the blood brain barrier(BBB)and trigger an inflammatory cascade;monocytes can participate in the immune response by promoting the secretion of inflammatory factors,and a higher level of monocytes indicates a poor prognosis in ICH;Platelet count also plays an important role in the prognosis of ICH.In ischemic stroke,both LMR and SII show encouraging predictive value,but current data on hemorrhagic stroke are limited and controversial.ObjectiveTo evaluate the relationship between LMR and SII in sICH patients and their 3-month prognosis.MethodsA total of 171 patients who were hospitalized for sICH in the Hospital from September 2019 to July 2020 were retrospectively collected as research subjects.171 patients with slCH were classified into a good prognosis group(mRS 0-2)and a poor prognosis group(mRS≥3 or "death")according to the 3-month modified Rankin Scale(mRS)score.The white blood cell count was calculated by a routine blood test within 24 hours of the onset of stroke symptoms,and the ratio of lymphocyte to monocyte count was calculated as LMR0.The ratio of the count to monocytes was identified as LMR1,LMR3,LMR7,and LMR14,and the total number of platelets multiplied by the ratio of neutrophils to lymphocytes at different time points was SII0,SII1,SII3,SII7 and SII 14.Logistic regression analysis was utilized to study the influence of slCH risk factors for poor 3-month prognosis for patients.Results1.Lower LMR at 24 hours after admission was independently associated with poor 3-month prognosis in patients with sICH(OR 0.392,95%CI 0.281-0.547,P<0.0001);2.A lower GCS score at 24 hours after admission was independently associated with poor 3-month prognosis in patients with sICH(OR 0.821,95%CI 0.747-0.902,P<0.0001);3.Previous heart disease history was independently associated with poor 3-month prognosis in patients with sICH(OR 6.307,95%CI 1.381-30.196,P=0.021);4.SII at 24 hours after admission was not independently associated with poor 3-month prognosis in patients with sICH;5.The ROC curve showed that the AUC of LMR0 was 0.799(P<0.0001,95%CI 0.729-0.825),the sensitivity was 93.07%(95%CI 86.2-97.2),while the specificity was 52.86%(95%CI 40.6-64.9),Youden index was 0.4593,the best cutoff value was 3.6,and the AUC of GCS score was 0.696(P<0.0001,95%CI 0.620-0.764),the sensitivity was 76.77%(95%CI 67.2-84.7),while the specificity was 60.29%(95%CI 47.7-72.05),the Youden index was 0.3706,and the best cutoff value was 10;the AUC of SII0 was 0.656(P=0.0002,95%CI 0.583-0.730),and the sensitivity was 91.09%(95%CI 83.8-95.8),while the specificity was 37.14%(95%CI 25.9-49.5),Youden index was 0.2823,and the best cutoff value was 850.23.Delong test showed that the difference between the area under the curve of LMR0 and GCS score was 0.103,the Z statistic was 1.844,P=0.0651,which was not statistically significant;the difference between the GCS score and the area under the SII0 was 0.040,the Z statistic was 0.698,P=0.4851,there was no statistical significance;the diffrence between the area of LMR0 and SII0 was 0.132,the Z statistic was 3.913,P=0.0001,the difference in the predictive value of the two indicators was statistically significant,indicating that for the 3-month prognosis of sICH patients,the predictive value of LMR at 24 h after admission was higher than that of SII.ConclusionThe lower LMR at 24h after admission was a predictive indicator for poor 3-month prognosis for slCH patients,and the optimal cutoff point was 3.6,and LMR has a high predictive power for the prognosis of sICH. |
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