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Introduction: Immune dysregulation has long been implicated in the development of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). The neutrophil-lymphocyte ratio (NLR) is an established prognostic marker in patients with cancer, cardiac disease, or sepsis. This study sought to determine whether there is a relationship between NLR and DCI in SAH patients.Methods: We evaluated 340 aneurysmal SAH patients between 2002 and 2015 enrolled into a single center, retrospective, observational cohort study. Admission NLR was analyzed using a ≥10 cutoff. DCI from cerebral vasospasm was defined as (1) clinical deterioration (i.e., a new focal deficit, decrease in level of consciousness, or both), and/or (2) a new infarct on CT that was not visible on the admission or immediate postoperative scan, when the cause was thought by the research team to be vasospasm. Logistic regression models were generated.Results: We found that 132 (39%) patients had an admission NLR ≥ 10. Admission NLR predicted development of DCI (OR: 1.7; 95% CI: 1.1- 2.5, p=0.008) after controlling known predictors including age and incidence of rebleed.Conclusions: This study shows that the admission NLR provides further evidence to the association between inflammation and DCI. Admission NLR is a readily available biomarker that may be a clinically useful tool for prognostication when evaluating SAH.