The diagnostic value of the neutrophil-lymphocyte ratio in distinguishing between subarachnoid hemorrhage and migraine
The diagnostic value of the neutrophil-lymphocyte ratio in distinguishing between subarachnoid hemorrhage and migraine
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DOI：
10.1016/j.ajem.2017.03.063
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发表时间：
2017-09-01
影响因子：
3.6
通讯作者：
Karaca, Yunus
中科院分区：
文献类型：
--
作者：
Eryigit, Umut;Cakmak, Vildan Altunayoglu;Karaca, Yunus
目的：偏头痛和蛛网膜下腔出血(SAH)患者出现在急诊科，其症状与头痛、恶心和呕吐相似。本研究探讨中性粒细胞-淋巴细胞比率(NLR)能否区分SAH患者和偏头痛患者。方法：这项回顾性研究是在研究伦理委员会批准后进行的。数据从2015年1月至2016年1月期间从一所大学医院的急诊科和神经科诊所收集，患者的症状包括头痛(主要)、恶心和呕吐。其中蛛网膜下腔出血121例，偏头痛123例，其他原发头痛综合征987例。入院时比较两组间中性粒细胞-淋巴细胞比率(NLR-1)。结果：SAH患者NLR值的中位数明显高于偏头痛和其他头痛患者(P<；0.001；P<；0.001)。偏头痛组和对照组之间NLR值差异无统计学意义(p>；0.05)。NLR分界值为4.02时，敏感性为85.95%，特异性为97.46%，阳性似然比(LR+)为33.79，阴性似然比(LR-)为0.14。在SAH患者中，NLR-2的中位数与NLR-1的中位数相比有统计学意义(p<；0.001)。结论：在这项回顾分析中，NLR将SAH患者与偏头痛患者区分开来。当观察到首次入院和再入院之间的NLR增加时，应评估出院和再入院的患者(有头痛症状)是否存在SAH。(C)2017 Elsevier Inc.保留所有权利。
Objective: Migraine and subarachnoid hemorrhage (SAH) patients present to emergency departments with the similar symptoms as headache, nausea, and vomiting. This study investigated whether the neutrophil-lymphocyte ratio (NLR) could distinguish patients with SAH from those with migraine.Methods: This retrospective study was performed after research ethics committee approval. Data were gathered from the ED and neurology clinics of a university hospital between January 2015 and January 2016, from patients with symptoms of headache (primarily), nausea and vomiting. One hundred and twenty one with SAH, 123 patients with migraine and 987 with other primary headache syndromes were considered. Neutrophil-lymphocyte ratios (NLR-1) were compared between groups on admission. In SAH patients NLR taken on the 24th-30th hour of admission (NLR-2) was compared to admission NLR.Results: NLR values, showed that the median NLR values of SAH patients were significantly higher than migraine and other headaches group values (p < 0.001; p < 0.001). There was no statistically significant difference between the NLR values of the migraine and control groups (p > 0.05). An NLR cut-off value of 4.02 produced 85.95% sensitivity, 97.46% specificity, a 33.79 positive likelihood ratio (LR+), and a 0.14 negative likelihood ratio (LR-). A statistically significant increase was observed in median NLR-2 values compared to median NLR-1 values in SAH patients (p < 0.001).Conclusion: In this retrospective analysis, NLR distinguished patients with SAH from those with migraine. Presence of SAH should be evaluated from discharged and readmitted patients (with headache symptoms) when an increase in NLR between initial and readmission levels is observed. (C) 2017 Elsevier Inc. All rights reserved.