Increased Neutrophil-to-Lymphocyte Ratio is Associated with Unfavorable Functional Outcome in Acute Ischemic Stroke

Giede-Jeppe, Antje; Madžar, Dominik; Sembill, Jochen A.; Sprügel, Maximilian I.; Atay, Selim; Hoelter, Philip; Lücking, Hannes; Huttner, Hagen B.; Bobinger, Tobias

doi:10.1007/s12028-019-00859-5

Cited by 33 publications

(26 citation statements)

References 37 publications

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“…NLR is regarded as a useful marker that can simultaneously reflect the negative effects of neutrophils and the positive effects of lymphocytes in stroke patients (Gibson et al., 2010; Gökhan et al., 2013). An increase in NLR has also been found to be a useful prognostic predictor in patients suffering from AIS (Giede‐Jeppe et al., 2019; Qun et al., 2017; Wang et al., 2019). In the present study, neither neutrophils nor lymphocytes had significant effects.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral circulating leukocytes, recruited by immune mediators, are known to be critical in the processes that cause neuronal damage following stroke (Kim et al., 2016; Rayasam et al., 2018). The neutrophil‐to‐lymphocyte ratio (NLR), which reflects the number of neutrophils and lymphocytes in the peripheral circulation, has previously been shown to be related to a poor functional outcome in patients suffering from acute intracerebral hemorrhage (Lattanzi et al., 2016), subarachnoid hemorrhage (Tao et al., 2017), and AIS (Giede‐Jeppe et al., 2019; Qun et al., 2017; Wang et al., 2019). However, previous research investigating the relationship between NLR and poor outcome in patients suffering from AIS did not exclude patients with in‐hospital pneumonia (IHP), a potential confounder.…”

Section: Introductionmentioning

confidence: 99%

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High neutrophil‐to‐lymphocyte ratio is a predictor of poor short‐term outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis

Liu

et al. 2020

Brain and Behavior

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High neutrophil‐to‐lymphocyte ratio is a predictor of poor short‐term outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis

Liu

et al. 2020

Brain and Behavior

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“…The association between the NLR and HT in AIS has not been fully explored yet. Previous studies have shown that NLR is a predictor of functional outcome in patients with AIS and intracerebral hemorrhage [ 18 , 19 , 20 ], but their clinical usefulness in sHT after IVT and MT is unknown.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio and Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients Undergoing Revascularization

et al. 2020

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Objectives: Symptomatic hemorrhagic transformation (sHT) is a life-threatening complication of acute ischemic stroke (AIS). The early identification of the patients at increased risk of sHT can have clinically relevant implications. The aim of this study was to explore the validity and accuracy of the neutrophil-to-lymphocyte ratio (NLR) in predicting sHT in patients with AIS undergoing revascularization. Methods: Consecutive patients hospitalized for AIS who underwent intravenous thrombolysis, mechanical thrombectomy or both were identified. The NLR values were estimated at admission. The study endpoint was the occurrence of sHT within 24 h from stroke treatment. Results: Fifty-one patients with AIS were included, with a median age of 67 (interquartile range, 55–78) years. sHT occurred in 10 (19.6%) patients. Patients who developed sHT had higher NLR at admission. NLR was an independent predictor of sHT and showed good discriminatory power (area under the curve 0.81). In a multivariable analysis, NLR and systolic blood pressure were independently associated with sHT. Conclusions: NLR at admission can accurately predict sHT in patients with AIS undergoing revascularization.

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“…NLR has been identified to be a useful clinical predictor of outcome in AIS patients being considered for mechanical thrombectomy, as NLR can predict functional dependence and mortality after adjustment for potential confounders that included vascular risk factors. Multiple analyses reveal NLR correlates with a greater functional disability at admission and at three months (increased mRS and NIHSS scores) and increased 90-day mortality (21)(22)(23)(24)(25)(26)(27) and was furthermore associated with length of hospital stay (28) and cost (29). Patients with NLR >3.3 were 2-times more likely to be at risk of death (24).…”

Section: Resultsmentioning

confidence: 99%

Universally Available Innate and Adaptive Immune Cell Counts in Acute Ischemic Stroke (AIS) in the Context of Shared Pathobiology with COVID-19; Scoping Review

Wijeratne¹,

Sales²,

Menon³

et al. 2021

Preprint

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Stroke is one of the leading cause of adult disability and the second leading cause of death worldwide. The immune system actively participates in the pathobiological process of AIS, during the index event and during the repair process despite the limited attention drawn to this aspect in the existing stroke guidelines globally. The similar clinical course and similar circulating innate and adaptive immune cell counts in AIS and COVID-19 has created a renewed interest in these easily available biomarkers innate and adaptive immunological changes in AIS with potential diagnostic, prognostic, and therapeutic implications. The current scoping review aimed to assess the significance of circulating neutrophil and lymphocyte counts and their ratio (NLR) in AIS and explore their association with post-stroke recovery trajectory. The Arksey and O'Malley methodological framework was employed to review the published papers on the neutrophil-lymphocyte ratio (NLR) and AIS in late November 2020. Only studies published in English from 2000-2020 were included in this scoping review. Fifty-three published papers were reviewed. This review's key finding is that a canonical inflammatory response occurs in AIS just as in the case of COVID-19 and neurological involvements well described in the recent literature. An excessive circulating innate immune cells (neutrophils) and reduced circulating adaptive immune cells (lymphocytes ) are associated with poorer outcomes during the acute interventions ( reperfusion therapies) as well as the recovery trajectory. Main representatives of innate and adaptive immunity follow a canonical course in AIS and COVID-19. Exaggerated circulating innate ( elevated neutrophils and elevated NLR) and reduced adaptive immune response (lymphopenia) correlate with the worse outcome in AIS and COVID-19. This scoping review's findings make the strongest case for a systems biology-based approach to the standard operating procedures in stroke care urgently.

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Increased Neutrophil-to-Lymphocyte Ratio is Associated with Unfavorable Functional Outcome in Acute Ischemic Stroke

Cited by 33 publications

References 37 publications

High neutrophil‐to‐lymphocyte ratio is a predictor of poor short‐term outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis

High neutrophil‐to‐lymphocyte ratio is a predictor of poor short‐term outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis

Neutrophil-to-Lymphocyte Ratio and Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients Undergoing Revascularization

Universally Available Innate and Adaptive Immune Cell Counts in Acute Ischemic Stroke (AIS) in the Context of Shared Pathobiology with COVID-19; Scoping Review

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