Admission WBC and NLR remained associated with unfavorable discharge outcome after adjustment and improved discrimination beyond established severity measures, supporting their use in preliminary short-term risk assessment after spontaneous intracerebral hemorrhage.
Each 1 × 10⁹/L increase in admission WBC was independently associated with higher odds of unfavorable discharge outcome after spontaneous intracerebral hemorrhage.
Each doubling of NLR was independently associated with higher odds of unfavorable discharge outcome after spontaneous intracerebral hemorrhage.
Adding WBC and NLR to the ICH score significantly improved discrimination for unfavorable discharge outcome.
Adding WBC and NLR to a clinical severity model also significantly improved discrimination, though the incremental gain was smaller.
An exploratory outcome-derived WBC-NLR burden classification showed reasonable discrimination that improved substantially when clinical covariates were added.
Nearly half of the study cohort experienced an unfavorable discharge outcome following spontaneous intracerebral hemorrhage.
The study authors explicitly cautioned that discharge mRS outcome should not be interpreted as a substitute for 90-day functional outcome.
This research examined whether two routine blood test measurements taken at hospital admission — the total white blood cell count (WBC) and a ratio of two types of immune cells called the neutrophil-to-lymphocyte ratio (NLR) — could help predict how well patients would recover after a brain bleed (spontaneous intracerebral hemorrhage, or sICH). The study looked back at records from 752 patients admitted to a hospital in China over four years. About 48% of patients had a poor functional outcome at discharge, meaning they had significant disability or worse. The researchers found that higher WBC and higher NLR at admission were both independently linked to worse outcomes, even after accounting for other factors like the severity of the stroke. This research suggests that adding WBC and NLR to existing clinical tools used to assess stroke severity could meaningfully improve doctors' ability to identify patients at higher risk of poor outcomes early in their hospital stay. When WBC and NLR were added to a well-known stroke severity score (the ICH score), the accuracy of outcome prediction improved substantially. When added to a more detailed clinical model, there was still a statistically significant improvement. These are standard, inexpensive blood tests already routinely collected at admission, making them practical additions to early risk assessment without extra cost or procedures. However, the study has important limitations to keep in mind. It was conducted at a single hospital and looked only at outcomes at the time of hospital discharge rather than longer-term recovery (such as 90-day functional status), so the findings may not fully reflect patients' ultimate recovery. The authors also developed an exploratory classification system based on combined WBC and NLR levels, but caution that this requires testing in other patient populations before it could be used clinically. Overall, this study adds to evidence that inflammation markers measurable at admission may provide useful prognostic information in the acute setting for brain hemorrhage patients.
Li G, Wang G, Hui Y, Xiong X, Wang H, Hou B. (2026). Admission White Blood Cell Count and Neutrophil-to-Lymphocyte Ratio for Early Risk Stratification after Spontaneous Intracerebral Hemorrhage: A Retrospective Cohort Study.. Brain and behavior. https://doi.org/10.1002/brb3.71786