Objective To investigate the levels of neutrophil degranulation factors ［myeloperoxidase （MPO）， neutrophil elastase （NE）， cellular fibronectin （cFn）， and urokinase-type plasminogen activator receptor （uPAR）］ and neutrophil-to-lymphocyte ratio （NLR） in peripheral blood of patients with massive cerebral infarction （MCI）， as well as their value in predicting brain herniation and their influence on short-term prognosis.Methods A total of 95 MCI hospitalized patients from January 2018 to December 2021 were enrolled. According to whether they developed brain herniation within 5 days after the onset of MCI， they were divided into a non-brain herniation group with 32 patients and a brain herniation group with 63 patients. Eight patients were lost to follow-up. According to the modified Rankin Scale （mRS） score at the time of follow-up， the patients were divided into a good prognosis group with 18 patients （mRS score ≤2 points） and a poor prognosis group with 69 patients （mRS score >2 points）. The correlation of the National Institutes of Health Stroke Scale （NIHSS） score with NLR， MPO， and NE levels was analyzed. The multivariate logistic regression analysis was used to investigate the risk factors for the development of brain herniation. The receiver operating characteristic （ROC） curve was used to assess the clinical value of NLR and MPO in predicting brain herniation. The levels of NLR and MPO were compared between the good prognosis group and the poor prognosis group.Results There were significant differences between the brain herniation group and the non-brain herniation group in the proportion of patients undergoing decompressive craniectomy， white blood cell count， neutrophil count and NLR， MPO， NE， cFn， and uPAR levels （P<0.05）. NIHSS score was positively correlated with NLR， MPO， and NE levels （r=6.524， 6.895， 7.236 respectively， P<0.05）. NLR （OR=2.361， P=0.007） and MPO （OR=2.955， P=0.014） were risk factors for the development of brain herniation in patients with MCI. NLR had an area under the ROC curve （AUC） of 0.914 （95%CI： 0.875-0.921） in predicting brain herniation in patients with MCI， while MPO had an AUC of 0.817 （95%CI： 0.802-0.856）， suggesting that NLR had a significantly larger AUC than MPO （Z=4.201， P=0.008）. The good prognosis group had significantly lower levels of NLR and MPO than the poor prognosis group （P<0.001）.Conclusions The levels of NLR and MPO on admission are risk factors for brain herniation in patients with MCI. NLR has a higher clinical value than MPO in predicting the development of brain herniation in patients with MCI. NLR and MPO levels are associated with prognosis in patients with MCI. ［Journal of International Neurology and Neurosurgery， 2023， 50（2）： 23-28］