Clinical Value and Prognosis of C Reactive Protein to Lymphocyte Ratio in Severe Aneurysmal Subarachnoid Hemorrhage

Qingqing Zhang; Gaoqi Zhang; Lintao Wang; Wanwan Zhang; Fandi Hou; Zhanqiang Zheng; Yong Guo; Zhongcan Chen; Juha Hernesniemi; Hugo Andrade-Barazarte; Guang Feng; Jianjun Gu

doi:10.3389/fneur.2022.868764

Clinical Value and Prognosis of C Reactive Protein to Lymphocyte Ratio in Severe Aneurysmal Subarachnoid Hemorrhage

Front Neurol. 2022 Jun 13:13:868764. doi: 10.3389/fneur.2022.868764. eCollection 2022.

Authors

Qingqing Zhang^{1

2}, Gaoqi Zhang^{1

2}, Lintao Wang², Wanwan Zhang^{1

2}, Fandi Hou¹, Zhanqiang Zheng¹, Yong Guo¹, Zhongcan Chen^{1

3}, Juha Hernesniemi³, Hugo Andrade-Barazarte³, Guang Feng^{1

3}, Jianjun Gu^{1

2}

Affiliations

¹ Department of Neurosurgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
² School of Clinical Medicine, Henan University, Kaifeng, China.
³ Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China.

Abstract

Objective: To investigate the relationship between CLR and disease severity and clinical prognosis of aSAH.

Methods: The authors retrospectively analyzed the clinical data of 221 patients with aSAH, who were admitted to the intensive care unit from January 2017 to December 2020. The indicators of inflammatory factors in the first blood routine examination within 48 h of bleeding were obtained. The prognosis was evaluated by mRS score at discharge, mRS>2 was a poor outcome. Through the receiver operating characteristic (ROC) curve, the area under the curve was calculated and the predicted values of inflammatory factors (CLR, CRP, WBC, and neutrophils) were compared. Univariate and multivariable logistic regression analyses were used to evaluate the relationship between CLR and the clinical prognosis of patients. ROC curve analysis was performed to determine the optimal cut-off threshold, sensitivity, and specificity of CLR in predicting prognosis at admission.

Results: According to the mRS score at discharge, 139 (62.90%) patients were classified with poor outcomes (mRS>2). The inflammatory factor with the best predictive value was CLR, which had an optimal cut-off threshold of 10.81 and an area under the ROC curve of 0.840 (95%CI.788-0.892, P < 0.001). Multivariable Logistic regression analysis showed that the Modified Fisher grade, Hunt-Hess grade, and CLR at admission were independent risk factors for poor outcomes of patients with aSAH (P < 0.05). According to Hunt-Hess grade, patients were divided into a mild group (Hunt-Hess ≤ 3) and a severe group (Hunt-Hess > 3), and the CLR value was significantly higher in severe patients with aSAH than in mild patients. The optimal cut-off threshold of CLR in the severe group was 6.87, and the area under the ROC curve was 0.838 (95% CI.752-0.925, P < 0.001).

Conclusions: The CLR value at the admission of patients with aSAH was significantly associated with Hunt-Hess grade, The higher Hunt-Hess grade, the higher the CL R-value, and the worse the prognosis. Early CLR value can be considered as a feasible biomarker to predict the clinical prognosis of patients with aSAH.

Keywords: C-reactive protein (CRP); C-reactive protein to lymphocyte ratio (CLR); aneurysmal subarachnoid hemorrhage (aSAH); lymphocytes; outcome; prognosis.

Publication types

Review