Association of a High Neutrophil-to-Lymphocyte Ratio with Hyperdense Artery Sign and Unfavorable Short-Term Outcomes in Patients with Acute Ischemic Stroke

Abstract

Purpose Immune–inflammatory processes are involved in all the stages of stroke. This study investigated the association of the neutrophil-to-lymphocyte ratio (NLR) with the hyperdense artery sign (HAS) observed on brain computed tomography (CT) and with clinical features in patients with acute ischemic stroke. Methods We retrospectively enrolled 2903 inpatients with acute ischemic stroke from May 2010 to May 2019. Data collected included imaging studies, risk factors, laboratory parameters, and clinical features during hospitalization. Results The HAS was identified in 6% of the 2903 patients and 66% of the 236 patients with acute middle cerebral artery occlusion. Patients with the HAS had a higher NLR. HAS prevalence was higher in men and patients with cardioembolism. The NLR exhibited positive linear correlations with age, glucose and creatinine levels, length of hospital stay, initial National Institutes of Health Stroke Scale (NIHSS) scores, and mRS scores at discharge. The NLR was significantly higher in patients with large-artery atherosclerosis and cardioembolism and was the highest in patients with other determined etiology. Multivariate analysis revealed that an initial NIHSS score of ≥10 and an NLR of >3.5 were significant positive factors, whereas diabetes mellitus and age > 72 years were significant negative factors for the HAS, with a predictive performance of 0.893. An initial NIHSS score of ≥5, positive HAS, age > 75 years, diabetes mellitus, an NLR of >3.5, female sex, a white blood cell count of >8 × 10 3 /mL, and elevated troponin I were significant predictors of unfavorable outcomes, with a predictive performance of 0.886. Conclusion An NLR of >3.5 enabled an efficient prediction of CT HAS. In addition to conventional risk factors and laboratory parameters, both an NLR of >3.5 and CT HAS enabled improved prediction of unfavorable stroke outcomes.

Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis

“…Various studies have shown that NLR is closely related to AIS dysfunction, short-term mortality, stroke severity on admission, primary unfavorable functional outcome, recurrent ischemic stroke and post stroke infections, greater risk of symptomatic intracranial hemorrhage, poor 3-month functional outcome, and 3-month mortality in AIS patients undergoing reperfusion treatments, which is consistent with our results (Xue et al, 2017;Kocaturk et al, 2019;Chen et al, 2020;Giede-Jeppe et al, 2020;He et al, 2020;AltinbaŞ et al, 2021;Bi et al, 2021;Ferro et al, 2021;Gong et al, 2021;Hu et al, 2021;Huang et al, 2021;Lin et al, 2021). In a recent study, NLR ≥ 9 was an independent predictor of new in-hospital neurologic complications (Heuschmann et al, 2004).…”

Comparison of Clinical Features, Immune-Inflammatory Markers, and Outcomes Between Patients with Acute In-Hospital and Out-of-Hospital Ischemic Stroke

“…26 Reports have demonstrated that the immune-inflammatory markers increase linearly with the initial NIHSS and the discharge mRS scores. 7,14 We obtained the same results among patients with OHIS. Large-artery atherosclerosis and cardioembolism, which usually cause higher stroke severity with higher NIHSS scores, account for more than threequarters of IHIS cases.…”

“…9 Several immune-inflammatory markers, such as the neutrophil counts (NC), platelet-to-lymphocyte ratio (PLR), neutrophil-tolymphocyte ratio (NLR), and systemic immune-inflammation index (SII), have been reported to be associated with poor outcomes among patients with acute stroke, cardiovascular disease, and various types of cancer. 7,[10][11][12][13][14] However, alterations in immune-inflammatory markers have rarely been described in patients with IHIS. In this study, we investigated the differences of clinical features, four immune-inflammatory markers (NC, PLR, NLR, and SII), and the outcomes between patients with IHIS and those with OHIS.…”

Identification of an miRNA Regulatory Network and Candidate Markers for Ischemic Stroke Related to Diabetes

“… 29 Acute ischemic stroke patients show an elevated ratio of neutrophils to lymphocytes and worse prognosis. 30 T cells are involved in the late phase of cerebral ischemia, and different T cell subtypes play different roles in ischemic stroke. 31 Our results link down-regulation of resting mast cells with greater risk of ischemic stroke.…”