Neutrophil-to-Lymphocyte Ratio in Predicting Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage in a Tertiary Care Hospital in Nepal

Abstract

Background

Aneurysmal subarachnoid hemorrhage (aSAH), caused by a ruptured intracranial aneurysm, results in high mortality and disability rates. Timely prognosis is crucial to guide treatment and optimize the allocation of healthcare resources. The Neutrophil-to-lymphocyte ratio (NLR), a simple yet effective marker, can aid in early prognosis of aSAH, holds potential as a valuable prognostic tool, especially in resource-constrained settings. 

Aims

The primary aim of study was to predict the outcome of aSAH patients by modified Rankin Scale (mRS) in three months based on admission Neutrophil-to-lymphocyte ratio (NLR).

Methodology

This observational study was conducted at a Tribhuvan University Teaching Hospital from June 2022 to August 2023. Patients with aSAH presenting to the Emergency Department within 72 hours of symptoms were included. Hematological investigations and non-contrast computed tomography of the head were performed.  Outcomes were assessed using the mRS after three months.

Results

Patients with poor outcomes had significantly higher admission NLR (7.1 ± 4.7) compared to those with good outcomes (3.7 ± 1.9).  Elevated NLR was significantly associated with worse outcomes at three months (p = 0.001). An NLR ≥ 3.63 predicted poor prognosis with 87.5% sensitivity.

Conclusion

This study highlights the utility of NLR in predicting outcomes in aSAH, providing an easy-to-access prognostic marker for risk stratification. The findings are relevant in developing countries, where financial and logistical constraints limit access to advanced neuroimaging and continuous monitoring.

Keywords

Aneurysmal Subarachnoid Hemorrhage, Neutrophil-to-Lymphocyte Ratio, Modified Rankin Scale, Outcome