Background and Aim: The neutrophil-to-lymphocyte ratio (NLR) in whole blood is an indicator of prognosis in several disorders; however, its predictive value in the cerebrospinal fluid (CSF) of hydrocephalus patients has not been studied. Accordingly, this study determines the prognostic relevance of NLR at admission and its implications for clinical outcomes in patients with hydrocephalus treated with an external ventricular drain (EVD).
Methods and Materials/Patients: This retrospective study examined consecutive individuals with hydrocephalus who were admitted to an adult intensive care unit in a single center between 2020 and 2022. Patient demographics, clinical characteristics, laboratory data, and computed tomography (CT) scans were gathered. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal NLR and clinical variable cutoff values for mortality. Univariate and multivariate logistic regression analyses were carried out to assess the independent impact of variables on mortality.
Results: This study included 40 patients with hydrocephaly in the present study. There were 24 males (60%) and 16 females (40%) patients, with an average age of 51.68±16.34 years. NLR was considerably higher in the dead group compared to the alive group (8.49±6.53 vs 5.05±3.78; P=0.027). In a model of ROC analysis, NLR (area under curve [AUC]=0.702, 95% confidence interval [CI], 0.537%, 0.836%; P=0.0171), age (AUC=0.674; 95% CI, 0.507%, 0.813%; P=0.0496), underlying disease (AUC=0.650; 95% CI, 0.483%, 0.794%; P=0.0126), and level of consciousness level (AUC=0.946; 95% CI, 0.825%, 0.993%; P<0001) were significantly associated with mortality. The best predictive threshold of the NLR was 8.88 (sensitivity=40% and specificity=100%). Univariate analysis revealed that NLR in the three groups by Glasgow coma scale (GCS) in coma and semicoma is more substantially connected to mortality than in the stupor group (P<0.05). According to an adjusted multivariate logistic regression analysis, the level of consciousness upon admission was an independent predictor of mortality and was positively linked with mortality (odds ratio (OR)=0.23; 95% CI, 0.08%, 0.65%; P=0.005). Furthermore, the multivariable analysis demonstrated that NLR > 8.88 in combination with GCS<8 (coma and semicoma) on admission had a higher prognostic value for mortality (P<0.0001).
Conclusion: In the current research, a high NLR (>8.88) in CSF was associated with an increased risk of mortality in individuals with hydrocephalus. When paired with a GCS score of <8, admission NLR>8.88 considerably improves the accuracy of predicting outcomes following EVD.