Journal of neurointerventional surgery
September 14, 2026 · via Europe PMC
Hematoma evacuation modifies the relationship between early changes in neutrophil-to-lymphocyte ratio and mortality after intracerebral hemorrhage.
White E, Eberle AT, Klavansky D, +7 more, Carvalho Poyraz F.
AI summary — for doctors, generated from the abstract only
After minimally invasive hematoma evacuation (SCUBA) for ICH, an early rise in neutrophil-to-lymphocyte ratio no longer predicted mortality, and mortality was much lower than in matched controls.
What was studied
Retrospective matched cohort of 514 ICH patients (264 SCUBA, 250 controls) analyzing early change in NLR and in-hospital mortality.
Key findings
- Baseline characteristics and admission NLR balanced
- In-hospital mortality 7.2% SCUBA vs 22.8% controls
- NLR change did not predict mortality after evacuation; specific statistics not fully captured in the abstract
Clinical relevance
This raises the hypothesis that hematoma evacuation may blunt inflammation-related secondary injury, but retrospective matching cannot exclude selection bias in the mortality difference.
Who should care
Limitations
Retrospective matched design with possible residual confounding; several results truncated.
Removing the clot may break the link between inflammation markers and death after ICH.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Neutrophil-to-lymphocyte ratio (NLR) is a prognostic indicator in intracerebral hemorrhage (ICH) thought to reflect systemic inflammation driving secondary brain injury. Recent evidence suggests that surgical hematoma evacuation improves long-term outcomes, presumably by reducing secondary brain injury triggered by hematoma-induced inflammation. We hypothesized that stereotactic intracerebral hemorrhage underwater blood aspiration (SCUBA), a minimally invasive hematoma evacuation technique, alters the association between early rise in NLR and outcomes in ICH patients.
Methods
We conducted a retrospective matched cohort study of 514 ICH patients: 264 underwent SCUBA and 250 were matched controls. Serial white blood cell (WBC) counts with differential were obtained from admission through hospital day 7. We analyzed relationships between the change in NLR from admission to hospital day 2 (delta NLR (ΔNLR)) and in-hospital mortality (primary outcome) using multivariable logistic regression, adjusting for ICH severity and infection status.
Results
Baseline characteristics, admission WBC count, and admission NLR were well-balanced without significant differences between groups. Hospital mortality was significantly lower in SCUBA patients (7.2% vs 22.8%, P<0.001). ΔNLR was independently associated with mortality (adjusted OR (aOR) 1.068 per unit increase, P=0.033). However, there was a significant interaction between SCUBA and ΔNLR (aOR 0.884, P=0.019). Predicted mortality probability remained low across NLR ranges in SCUBA patients while increasing sharply in the matched cohort.
Conclusions
Our findings suggest that SCUBA modifies the association between ΔNLR and mortality, such that NLR was not a predictor of outcome after hematoma evacuation. Further work is needed to determine whether hematoma evacuation alters systemic inflammatory pathways that drive secondary brain injury after ICH.
DOI
10.1136/jnis-2025-024271
PMID
41136211
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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