Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Potential Predictors of Prognosis in Acute Ischemic Stroke

Abstract

Objective: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been emerging as the novel inflammatory biomarkers for determining the prognosis of various diseases. This study aimed to investigate the individual and joint effects of NLR and PLR on functional outcomes of acute ischemic stroke (AIS).Methods: Our study involved 448 eligible patients with first-ever AIS. Clinical and laboratory data were collected on admission within 72 h from stroke onset. Unfavorable functional outcome was defined as a modified Rankin Scale score of 3–6 at 3 months after AIS. Cox proportional hazard model and spline regression models was used to estimate the effect of NLR and PLR on risk of adverse outcomes after the last patient who completed a 3-months follow-up was enrolled.Results: After adjusting confounders, NLR were significantly associated with the unfavorable functional outcomes (P-trend < 0.001). So were PLR (P-trend < 0.001). NLR was discovered to have higher predictive value than PLR (AUC = 0.776, 95%CI = 0.727–0.825, P < 0.001; AUC = 0.697, 95%CI = 0.641–0.753, P < 0.001). The optimal cutoff values for NLR and PLR was 3.51 and 141.52, respectively. Stratified analysis performed by cox proportional hazard model showed that high level of NLR and PLR (NLR ≥ 3.51, PLR ≥ 141.52) presented the highest risk of unfavorable functional outcomes (adjusted HR, 3.77; 95% CI: 2.38–5.95; P < 0.001). Followed by single high level of NLR (adjusted HR, 2.32; 95% CI: 1.10–4.87; P = 0.027). Single high level of PLR (NLR < 3.51, PLR ≥ 141.52) also showed higher risk than low level of the combination, but it did not reach statistical significance (adjusted HR, 1.42; 95% CI: 0.75–2.70; P = 0.285). No obvious additive [relative excess risk due to interaction (RERI) not significant] or multiplicative (adjusted HR, 0.71; 95%CI: 0.46–1.09; P = 0.114) interaction was found between the effects of NLR and PLR on the risk of unfavorable functional outcomes.Conclusion: This study demonstrated that both NLR and PLR were independent predictors of 3-months functional outcomes of AIS. They may help to identify high-risk patients more forcefully when combined together.

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).…”

Association of systemic inflammation indices with visual field loss progression in patients with primary angle-closure glaucoma: potential biomarkers for 3P medical approaches

“…Gong et al [ 66 ] reported that PLR (OR 1.013, 95% CI 1.009–1.016, P = 0.001) was an independent factor for early neurological deterioration post-thrombolysis. Chen et al[ 67 ] found that PLR was an independent predictor of 3-month functional outcomes in patients with acute ischemic stroke.…”

Acute Inflammation in Cerebrovascular Disease: A Critical Reappraisal with Focus on Human Studies

“…Clinically, high platelet CD84 expression levels were associated with poor outcome in patients with stroke [ 48 ] PLR was inferior to NLR as predictor of outcome and severe neurological complications such as edema in a larger cohort study [ 28 ]. Nevertheless, in patients with stroke, namely those submitted to IVT, higher PLR was independently associated with unfavorable outcome and death at 3 months after thrombolysis, correlating with NIHSS and GCS [ 49 , 50 , 51 , 52 ]. Regarding psychiatric impairment, higher PLR was associated with post-stroke disorder, and depression 6 months after stroke [ 53 ].…”