Neutrophil-to-Lymphocyte Ratio and Early Neurological Deterioration in Stroke Patients: A Systematic Review and Meta-Analysis

Abstract

In light of the growing emphasis on classifying stroke patients for different levels of monitoring intensity and emergency treatments, we conducted a systematic review of a wide range of clinical studies, according to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, with no restrictions on the language or publication date, to analyze the potential of the neutrophil-to-lymphocyte ratio (NLR) as an early neurological deterioration (END) risk predictor. A comprehensive search was carried out in PubMed, Scopus, and Web of Science databases from the inception to March 13, 2022. Nine articles were included in our study. Stroke patients with END had significantly higher NLR levels than the those without END ( SMD = 0.73 ; CI 95 % = 0.42 -1.05, P value < 0.001). In the subgroup analysis, according to ethnicity, East Asian patients with END had elevated levels of NLR compared to those without END ( SMD = 0.79 ; CI 95 % = 0.52 -1.06, P value < 0.001). However, the difference in the Caucasian group was not significant ( SMD = 0.60 ; CI 95 % = − 0.50 -1.70, P value = 0.28). In the subgroup analysis according to the type of stroke, the NLR levels in patients with hemorrhagic stroke who developed END were similar to those without END ( SMD = 0.84 , CI 95 % = − 0.10 -1.77, P value = 0.07). Vice versa, in the ischemic stroke group, patients with END had elevated levels of NLR compared to those without END ( SMD = 0.67 , CI 95 % = 0.38 -0.96, P value < 0.001). NLR is a unique inflammatory biomarker whose increase in END suggests an immune system dysfunction in the pathogenesis of the disease.

The Diagnostic Value of Neutrophil to Lymphocyte Ratio as an Effective Biomarker for Eye Disorders: A Meta-Analysis

“…Eye disorders are characterized by some degree of inflammatory burden [ 41 ]. On the other hand, NLR is associated with increased inflammation in various conditions such as type 2 DM [ 42 ], autoimmune conditions [ 43 ], stroke [ 44 , 45 ], thyroid disorders [ 46 ], functional bowel disease [ 47 ], and even COVID-19 infection [ 48 ]. In addition, there has been an increase in the number of papers related to the role of NLR in several eye diseases [ 3 – 31 , 35 , 37 , 38 ], and it has gained prominence as an early predictive marker for several eye diseases that were mentioned earlier.…”

The prognostic value of neutrophil-to-lymphocyte ratio in patients with traumatic brain injury: A systematic review

“…In another meta-analysis of 3641 acute ischemic stroke patients -who received intravenous thrombolysis-, higher NLR levels were linked to higher odds of hemorrhagic transformation (OR = 1.33; 95 % CI = 1.14–1.56; p < 0.001) and poor 90-day functional outcome (OR = 1.64; 95 % CI = 1.38–1.94; p < 0.001) ( 49 ). In the same context, stroke patients with early neurological deterioration (END) had higher NLR levels than those without END (SMD = 0.73; 95% CI = 0.42–1.05; p < 0.001) ( 50 ).…”

Conduction System Disease in Victims of COVID-19

“…Besides, acute myocardial infarction due to demand/supply imbalance and arterial thrombotic event secondary to hypercoagulable state can cause acute arrhythmias (18)(19)(20)(21). In addition, Stress-induced cardiomyopathy owing to physiological stress and cytokine storm about sepsis and high inflammatory state is another potential mechanism triggering arrhythmias (15,(22)(23)(24). Moreover, prolonged QTc-inducing malignant ventricular arrhythmias and channelopathies induced by off-label medical therapy and antiviral therapy could be introduced as direct triggers of arrhythmias (25)(26)(27)(28)(29).…”