The clinical significance of peripheral blood cell ratios in patients with intracranial aneurysm

Hyun Kyung Kim; Kee Ook Lee; Seung-Hun Oh; Kyung-Yul Lee; Seung-Wook Choo; Ok Joon Kim; Tae Gon Kim; Sang-Heum Kim; Sang-Jun Na; Ji Hoe Heo

doi:10.3389/fneur.2022.1080244

The clinical significance of peripheral blood cell ratios in patients with intracranial aneurysm

Front Neurol. 2022 Dec 20:13:1080244. doi: 10.3389/fneur.2022.1080244. eCollection 2022.

Authors

Hyun Kyung Kim¹, Kee Ook Lee¹, Seung-Hun Oh¹, Kyung-Yul Lee², Seung-Wook Choo^{1

3}, Ok Joon Kim¹, Tae Gon Kim⁴, Sang-Heum Kim⁵, Sang-Jun Na⁶, Ji Hoe Heo²

Affiliations

¹ Department of Neurology, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, South Korea.
² Departments of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
³ Department of Biomedical Laboratory Science, College of Natural Science, Daejeon University, Daejeon, South Korea.
⁴ Department of Neurosurgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, South Korea.
⁵ Department of Radiology, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, South Korea.
⁶ Department of Neurology, Konyang University College of Medicine, Daejeon, South Korea.

Abstract

Background and objective: Inflammation is an important factor in the development of aneurysm, and has been identified as a key characteristic predictive of rupture of intracranial aneurysm (IA). However, the role of inflammatory peripheral blood cell ratios in patients with IA has not been well delineated.

Methods: A total of 1,209 patients, including 1,001 with unruptured IA and 208 with ruptured IA, were enrolled in this study. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), and platelet-to-white-blood-cell ratio (PWR) were compared between ruptured and unruptured IA.

Results: Compared with the ruptured IA group, the unruptured IA group had higher PNR {median, 65.96 [interquartile range (IQR) 48.95-85.05] vs. 37.78 (IQR, 23.17-54.05); p < 0.001} and PWR [median, 36.89 (IQR 29.38-44.56) vs. 22.39 (IQR, 16.72-29.29); p < 0.001]. In multivariate analysis, PNR and PWR were independently associated with ruptured IA (p = 0.001 and p < 0.001, respectively). Unruptured IA subgroup analyses according to the PHASES scores showed that a higher PHASES score was associated with significantly higher NLR and erythrocyte sedimentation rate (p < 0.001 and p = 0.025) and lower PNR and PWR (p < 0.001 and p = 0.007).

Conclusions: We demonstrated that lower PNR and PWR levels are associated with ruptured IA and a higher PHASES score. Unlike many other inflammatory markers and bioassays, peripheral blood cell ratios are inexpensive and readily available biomarkers that may be useful for risk stratification in patients with cerebral aneurysm. However, a long-term prospective study is needed to clarify this matter.

Keywords: biomarkers; blood cell ratio; inflammation; intracranial aneurysm; rupture risk.