Study On The Value Of Neutrophil To Lymphocyte Ratio In Predicting The Prognosis Of Patients With Cerebral Venous Sinus Thrombosis

Background:Cerebral Venous Sinus Thrombosis(CVST),thrombus formed in cerebral vein and dural venous sinus,is a rare type of ischemic cerebrovascular disease,and the incidence rate of CYST among population with stroke registered at 0.5-1%,among which mostly are children and young people.With progress made in diagnostic techniques,the early diagnosis rate of CVST was significantly raised,which allows patients to receive adequate treatment and the early mortality rate was greatly reduced than before.However,the prognosis of neurological function in CVST patients varies greatly.At present,the risk factors for poor prognosis of CVST patients are mostly clinical symptoms and imaging characteristics,but lack of discussion on blood biomarkers.The level of known inflammatory infection plays an important role in the development of CVST.And increasing evidence shows leukocytes and their subtypes,neutrophil and neutrophil to lymphocyte ratio(NLR)can be listed as independent prognostic risk factors of cardiovascular disease,tumor,stroke and its complications.However,at present,few studies,neither domestic nor foreign,reported the relationship between leukocytes and their subtypes,NLR level and the prognosis of CVST patients.Objective:This study aims to explore the correlation between white blood cell(WBC),absolute neutrophil count(ANC),absolute lymphocyte count(ALC),NLR and the prognosis of CVST patients,and to evaluate their forecast value,so as to identify high-risk patients for clinicians and take potential intervention to improve clinical prognosis.Methods:Retrospective analysis was practiced to CVST patients who met the inclusion and exclusion criteria of the study in the department of neurology,emergency medicine,neurosurgery,neurological intensive and neuro-interventional department of the First Affiliated Hospital of Zhengzhou University from November 2011 to April 2019.The neurofunctional prognosis was evaluated according to modified Rankin Scale(mRS),mRS>2.was defined as poor outcome.The clinical characteristics of CVST patients were compared between poor and good outcome groups.Cox regression analysis was conducted to explore the association between NLR,ANC,ALC,WBC and the prognosis of CVST patients,Receiver Operating Characteristic curve(ROC)was applied to analyze NLR,ANC,ALC,WBC,and their value of predicting the prognostic of CVST patients were evaluated according to the Area Under the Curve(AUC),sensitivity and specificity.All subjects were divided into high-level group and low-level group according to the best cut-off point of NLR.The mortality rate in high and low NLR value groups was compared with the log-rank test and plotted with the use of Kaplan-Meier method.Meanwhile,we conducted multiple Cox regression analysis.Finally,we.conducted subgroup analyses with the use of Cox regression analysis in subgroup defined according to age(above vs below 45 years old),sex,history of infections and pregnancy/postpartum,presence of coma and intracerebral hemorrhage.Results:1.The study included 360 CVST patients whose median follow-up time was 9 months(6.3,17.5),among which 308 were grouped good outcome(85.6%),52 were grouped poor outcome(14.4%),including 38 cased of death(10.5%).2.Multivariate Cox regression analysis indicated that high level of NLR(HR=1.05;95%CI1.02-1.09;P=0.002).ANC(HR=1.04;95%CI 1.00-1.08;P=0.029),WBC(HR=1.04;95%CI 1.01-1.07;P=0.020)significantly increased the risk of poor outcome.Apart from that,high level of NLR(HR=1.06;95%CI 1.03-1.10;P<0.001),ANC(HR=1.05;95%CI 1.01-1.09;P=0.012),WBC(HR=1.05;95%CI 1.01-1.08;P=0.010)and low level of ALC(HR=0.44;95%CI 0.22-0.86;P=0.017)were associated with the mortality of CVST patients after discharge.3.According to the AUC of ROC in NLR,WBC,ANC and ALC,the best discriminating variable was the NLR in predicting mortality of CYST patients.The curve of AUC was 0.81(95%CI 0.76-0.85,P<0.001),the optimal cut-off point of NLR was 5.6.The sensitivity and specificity for predicting mortality of CYST patients were 84.2%and 69.9%,respectively.4.Multivariate Cox regression analysis indicates that compared with low level NLR group,high-level NLR group(HR=5.65,95%CI 2.33-13.73,P<0.001)significantly increased mortality of CVST patients after discharge.Further subgroup analyses showed similar results across age(above vs.below 45 years old),sex,history of infections and pregnancy/postpartum,presence of coma and intracerebral hemorrhage.Conclusions:High level of NLR,WBC and ANC at admission may be risk factors for the poor outcome and mortality of CYST patients after discharge.While low level of ALC may also be a risk factor for the mortality of CVST patients after discharge.