Brain Behav. 2026 Oct;16(10):e71786. doi: 10.1002/brb3.71786.
ABSTRACT
OBJECTIVE: To evaluate the adjusted associations and incremental prognostic value of admission white blood cell count (WBC) and neutrophil-to-lymphocyte ratio (NLR) for unfavorable discharge outcome after spontaneous intracerebral hemorrhage (sICH).
METHODS: Consecutive adults with CT-confirmed sICH admitted to a tertiary academic hospital in northwestern China from August 2021 through August 2025 were retrospectively reviewed. After eligibility screening, 764 patients formed the study cohort. Admission WBC and log2-transformed NLR were analyzed as continuous exposures; the primary outcome was discharge modified Rankin Scale (mRS) score ≥ 3. Multivariable models were benchmarked against the ICH score and a clinical severity model. Internal validation used 1000 bootstrap resamples. A three-level outcome-derived WBC-NLR burden classification was treated as exploratory and evaluated with 1000 nested bootstrap resamples.
RESULTS: The primary complete-case analysis included 752 patients, of whom 358 (47.6%) had an unfavorable discharge outcome. Each 1 × 109/L increase in WBC was associated with higher odds of unfavorable outcome (adjusted odds ratio [OR], 1.116; 95% CI, 1.035-1.204; p = 0.004), and each doubling of NLR was associated with an adjusted OR of 2.187 (95% CI, 1.687-2.835; p < 0.001). Adding WBC and NLR increased the ICH score AUC from 0.757 to 0.848 (ΔAUC, 0.091; p < 0.001) and the clinical model AUC from 0.875 to 0.909 (ΔAUC, 0.034; p < 0.001). The optimism-corrected AUC of the full model was 0.900, with a corrected calibration slope of 0.932 and Brier score of 0.129. The nested-bootstrap-corrected AUC was 0.776 for the exploratory burden-only model and 0.899 after adding clinical covariates.
CONCLUSIONS: Admission WBC and NLR remained associated with unfavorable discharge outcome after adjustment and improved discrimination beyond established severity measures. They may support preliminary short-term risk assessment, whereas the outcome-derived burden categories require external validation. The discharge endpoint should not be interpreted as a substitute for 90-day functional outcome.
PMID:42867108 | DOI:10.1002/brb3.71786