Author(s)

Jie Min ¹, Jian Zhao ¹, Lei Yang ², Fangju Mao ¹

Affiliation(s)

¹ Neurointensive Care Unit, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
² Department of Neurosurgery, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China

Corresponding Author

Jie Min

ABSTRACT

This study aimed to investigate the dynamic changes in the neutrophil-to-lymphocyte ratio (NLR) during the early postoperative period in patients with aneurysmal subarachnoid hemorrhage (aSAH) and to assess their predictive value for poor prognosis at discharge. A total of 248 aSAH patients were consecutively enrolled and classified into a favorable-prognosis group (mRS scores 0-2, n=193) and a poor-prognosis group (mRS scores 3–6, n=55) based on their discharge mRS scores. Peripheral blood neutrophil and lymphocyte counts were measured along with NLR calculation on admission day (0 d), 24 hours postoperatively (1 d), 72 hours postoperatively (3 d), and 7 days postoperatively (7 d). Differences in NLR at each time point were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of poor prognosis, and a combined predictive model was constructed. The model's discrimination power was evaluated using a receiver operating characteristic (ROC) curve, with internal validation conducted via bootstrap method. The poor-prognosis group exhibited higher age (64 vs. 59 years, P=0.012), a greater proportion of Hunt-Hess grades III–V (63.6% vs. 16.1%, P=0.000), and a higher incidence of intraventricular hemorrhage (56.4% vs. 23.8%, P=0.000). The NLR levels at 24 hours, 72 hours, and 7 days postoperatively were significantly higher in the poor-prognosis group compared to the good-prognosis group, with the most significant intergroup difference observed at 72 hours postoperatively (median: 10.81 vs. 6.33). Multivariate logistic regression identified Hunt-Hess grading III–V (OR=6.313,95% CI: 2.870–13.887, P=0.000), neck width (OR=1.335,95% CI: 1.058–1.686, P=0.015), and 72-hour postoperative NLR (OR=1.103,95% CI: 1.037–1.174, P=0.002) as independent predictors of poor prognosis at discharge. The predictive model constructed based on these three parameters exhibited an area under the ROC curve (AUC) of 0.839 (95% CI not provided, P<0.001), and internal validation using bootstrap calibration demonstrated good model fit. A significant elevation in 72-hour postoperative NLR is an independent risk factor for poor prognosis in aSAH patients, and the combined model incorporating Hunt-Hess grading and tumor neck width demonstrates excellent discriminative power. Dynamic monitoring of early postoperative NLR levels aids in the early identification of high-risk patients.

KEYWORDS

Aneurysmal subarachnoid hemorrhage; Neutrophil-to-lymphocyte ratio; Prognosis; Predictive model; Hunt-Hess grading system

CITE THIS PAPER

Jie Min, Jian Zhao, Lei Yang, Fangju Mao. Study on the correlation between postoperative dynamic NLR monitoring levels and clinical prognosis in patients with aneurysmal subarachnoid hemorrhage. MEDS Clinical Medicine (2026). Vol. 7, No. 3, 154-162. DOI: http://dx.doi.org/10.23977/medsc.2026.070320.

REFERENCES

[1] Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms[J]. J Neurosurg, 1968,28(1):14-20.
[2] Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning[J]. Neurosurgery, 1980,6(1):1-9.
[3] Serrone JC, Maekawa H, Tjahjadi M, et al. Aneurysmal subarachnoid hemorrhage: pathobiology, clinical features, and management[J]. Neurotherapeutics,2020,17(2):411-423.
[4] Giede-Jeppe A, Reichl J, Sprügel MI, et al. Neutrophil-to-lymphocyte ratio as an independent predictor for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage[J]. J Neurosurg, 2019,133(3):750-757.
[5] Al-Mufti F, Amuluru K, Damodara N, et al. Elevated neutrophil-to-lymphocyte ratio predicts delayed cerebral ischemia and poor outcome after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis[J]. World Neurosurg,2019,130:e678-e685.
[6] Chen Y, Zhang Y, Li Z, et al. Neutrophil-to-lymphocyte ratio >10.92 predicts poor outcome in patients with aneurysmal subarachnoid hemorrhage: a retrospective cohort study[J]. Front Neurol, 2022;13:862345.
[7] Mocco J, Wilson DA, Komotar RJ, et al. Alterations in plasma complement levels after human subarachnoid hemorrhage[J]. Neurosurgery, 2006,59(5):984-991.
[8] Provencio JJ, Vora N. Subarachnoid hemorrhage and inflammation: bench to bedside and back[J]. Semin Neurol, 2005,25(4):435-444.
[9] Savarraj JP, Parsha K, Hergenroeder GW, et al. Systematic review and meta-analysis of the role of neutrophils and neutrophil-to-lymphocyte ratio in subarachnoid hemorrhage[J].Neurosurg Rev,2021,44(4):1899-1910.
[10] Pálmason B, Söderberg J, Sundström N, et al. Neutrophil-to-lymphocyte ratio is associated with cerebral vasospasm and delayed cerebral ischemia after subarachnoid hemorrhage[J]. Acta Neurochir (Wien), 2020, 162(10):2471-2478.
[11] Zhang X, Liu D, Zhu Y, et al. Prognostic value of neutrophil-to-lymphocyte ratio in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis[J].Front Neurol, 2021,12:732456.
[12] Lucke-Wold B, Logsdon AF, Turner RC, et al. Endoplasmic reticulum stress modulation as a target for ameliorating the pathophysiology of subarachnoid hemorrhage[J]. J Neurol Neurophysiol, 2015,6(5):318.
[13] de Oliveira Manoel AL, Macdonald RL. Neuroinflammation as a target for intervention in subarachnoid hemorrhage[J]. Front Neurol, 2018, 9:877.
[14] Sadashiva N, Sharma M, Garg K, et al. Neutrophil-to-lymphocyte ratio as a predictor of outcome in aneurysmal subarachnoid hemorrhage: a prospective study[J]. World Neurosurg, 2020,143:e356-e362.
[15] Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2012,43(6):1711-1737.
[16] Jaja BN, Saposnik G, Lingsma HF, et al. Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study[J]. BMJ. 2018,360:j5745.

Sponsors, Associates, and Links

---

• Journal of Neurobiology and Genetics
  
  
• Medical Imaging and Nuclear Medicine
  
  
• Bacterial Genetics and Ecology
  
  
• Transactions on Cancer
  
  
• Journal of Biophysics and Ecology
  
  
• Journal of Animal Science and Veterinary
  
  
• Academic Journal of Biochemistry and Molecular Biology
  
  
• Transactions on Cell and Developmental Biology
  
  
• Rehabilitation Engineering & Assistive Technology
  
  
• Orthopaedics and Sports Medicine
  
  
• Hematology and Stem Cell
  
  
• Journal of Intelligent Informatics and Biomedical Engineering
  
  
• MEDS Basic Medicine
  
  
• MEDS Stomatology
  
  
• MEDS Public Health and Preventive Medicine
  
  
• MEDS Chinese Medicine
  
  
• Journal of Enzyme Engineering
  
  
• Advances in Industrial Pharmacy and Pharmaceutical Sciences
  
  
• Bacteriology and Microbiology
  
  
• Advances in Physiology and Pathophysiology
  
  
• Journal of Vision and Ophthalmology
  
  
• Frontiers of Obstetrics and Gynecology
  
  
• Digestive Disease and Diabetes
  
  
• Advances in Immunology and Vaccines
  
  
• Nanomedicine and Drug Delivery
  
  
• Cardiology and Vascular System
  
  
• Pediatrics and Child Health
  
  
• Journal of Reproductive Medicine and Contraception
  
  
• Journal of Respiratory and Lung Disease
  
  
• Journal of Bioinformatics and Biomedicine