Evaluation of Neutrophil-to-Lymphocyte Ratio Among Ischemic Stroke Subtypes and Stroke Severity

Abstract

Introduction Recently, neutrophil-to-lymphocyte ratio (NLR) has been proven to be useful in predicting severity, mortality, and morbidity of stroke. NLR is low cost and yet not used widely as a biomarker to predict prognosis. Aims We evaluated the association of NLR in severity of stroke and ischemic stroke subtypes. Methodology A total of 69 subjects with ischemic stroke onset within 24 h were included in the study and categorized according to TOAST classification. National Institutes of Health Stroke Scale was used to determine stroke severity at admission. Samples were obtained within 24 h of stroke onset and NLR measured which was later correlated with severity and subtypes of stroke. Results NLR and severity of stroke showed statistically significant association ( P < .05). Median (interquartile range [IQR]) of NLR was significantly high in severe cases (7.1 [4.03-7.698]), as compared to others. The area under the receiver operating characteristic curve for NLR to predict the stroke severity was 6.07 [area under the curve 0.764; 95% confidence interval: 0.647 to 0.858). When NLR was more than 6.07, there was 90.90% chances of moderate-to-severe stroke and with milder stroke, 93.10% had NLR of less than equal to 6.07. NLR and stroke subtypes also showed statistically significant association ( P < .05). Median (IQR) of NLR in embolic stroke was significantly high (4.75 [2.95-8.2]), as compared to other stroke subtypes. Conclusion NLR, at a cut-off 6, has moderate sensitivity and higher specificity in predicting stroke severity and NLR was high in embolic stroke among other stroke subtypes.

Risk Factors of In-Hospital Mortality of Ischemic Stroke Patients in Gunung Jati General Hospital

“…This finding is consistent with previous studies and aligns with the high prevalence of non-communicable diseases in the country. 5,6,11 Half of the patients in this study also had Consequently, various inflammatory markers also have been associated with unfavorable outcomes. In the prior study, mortality was associated with admission white blood cell count, fever, and positive cultures in ischemic stroke patients who underwent thrombectomy.…”

“…NLR was significantly associated with severe stroke and poor short-term prognosis and functional outcomes in previous studies. 5,7 NLR was also found to be linked with more severe cerebral edema, early involvement in the formation of NETs may contribute to these phenomena. 7,16 We found higher mortality in ischemic stroke patients with presenting atrial fibrillation.…”

“…3,4 In addition, length of stay, vital signs, age, hypertension, diabetes mellitus, previous stroke, aspiration pneumonia, and pre-existing heart disease showed an association with mortality in stroke patients. 5,6 Previous research has shown that inflammation markers were associated with atherosclerotic events and became an early predictor of severity and poor short-term prognosis in ischemic stroke since inflammation plays an essential role in the pathophysiology of stroke. 5,7 Predicting the mortality of stroke patients, identifying those at high risk, and providing them with optimal care remain challenges in developing countries like Indonesia.…”

“…5,6 Previous research has shown that inflammation markers were associated with atherosclerotic events and became an early predictor of severity and poor short-term prognosis in ischemic stroke since inflammation plays an essential role in the pathophysiology of stroke. 5,7 Predicting the mortality of stroke patients, identifying those at high risk, and providing them with optimal care remain challenges in developing countries like Indonesia. In addition, limited data on eISSN (Online): 2598-0580 stroke mortality predictors were available in our region.…”