Neutrophil-to-Lymphocyte Ratio as a Predictor of Short-Term Functional Outcomes in Acute Ischemic Stroke Patients

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR), a systemic inflammatory biomarker, has been associated with poorer outcomes in acute ischemic stroke patients. The present study was designed to expand these findings by investigating the association between NLR and short-term functional outcomes in acute ischemic stroke patients. Methods: This retrospective study evaluated patients within 7 days after the onset of acute ischemic stroke. Stroke severity on admission was measured using the National Institutes of Health Stroke Scale (NIHSS). The functional outcomes were assessed using the Berg Balance Scale (BBS), Manual Function Test (MFT), the Korean version of the modified Barthel Index (K-MBI), and the Korean Mini-Mental State Examination (K-MMSE) within 2 weeks of stroke onset. The modified Rankin Scale (mRS) was evaluated at discharge. Results: This study included 201 patients, who were grouped into three NLR tertiles (<1.84, 1.84–2.71, and >2.71) on admission. A multivariate analysis showed that the top tertile group (NLR > 2.71) had significantly higher risks of unfavorable outcomes on the K-MBI (p = 0.010) and K-MMSE (p = 0.029) than the bottom tertile group (NLR < 1.84). Based on the optimal cut-off values from a receiver operating characteristic curve analysis, a higher NLR was significantly associated with higher NIHSS scores (p = 0.011) and unfavorable outcomes on the K-MBI (p = 0.002) and K-MMSE (p = 0.001). Conclusions: A higher NLR is associated with poorer short-term functional outcomes in acute ischemic stroke patients.

Association of the Neutrophil-to-Lymphocyte Ratio with 90-Day Functional Outcomes in Patients with Acute Ischemic Stroke

“…The initial investigation of the relationship between the NLR and short-term mortality in stroke patients demonstrated that the NLR serves as an independent prognostic indicator of short-term mortality in AIS patients, with higher NLRs significantly associated with increased stroke-related mortality [33][34][35][36]. Min-Su Kim et al discovered a similar finding, indicating an optimal NLR threshold value of 2.09 [37]. Our study also provided evidence that the NLR is an independent factor for 3-month clinical functional outcomes in patients with AIS.…”

The Association of the Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio and Systemic Inflammation Response Index with Short-Term Functional Outcome in Patients with Acute Ischemic Stroke

“… 21 Kim et al found that the higher the NLR, the worse the short-term functional prognosis of AIS patients. 22 In addition, a study of 346 patients with AIS showed that the higher the NLR, the higher the incidence of adverse outcomes at discharge. 23 We included 861 AIS patients, and our findings suggested that the NLR was an independent risk factor for poor functional outcome at discharge, which was consistent with previous findings.…”

The Relationship of Lymphocyte/Monocyte Ratio with Clinical and Radiological Parameters and Its Effect of Short-Term Results in Stroke Patients

“…İnmenin başlamasından sonra, periferik kanda nötrofil sayısı kısa sürede artmaktadır (26). Yüksek NLO düzeyleri inme şiddeti, kısa dönemli ölüm oranı, kısa dönemli olumsuz fonksiyonel sonuçlar ve artmış tekrarlayan iskemik inme riski ile ilişkilendirilmiştir (7). Akut iskemik inmeli hastalarda kısa dönemli fonksiyonel sonuçların NLO ile ilişkisinin incelendiği bir çalışmada, NLO düzeyi yüksek olanlarda daha yüksek USİS ile daha düşük Barthel indeksi ve kısa minimental durum muayenesi puanları elde edilmiştir (7)…”

“…Hematolojik parametrelerin inme hastalarında ilk üç aylık klinik sonuçlar ile ilişkisine daha önce bakılmıştır (6) ancak hastanede yatış sırasındaki kısa süreli klinik sonuçlar ile ilişkisine ait çalışma sayısı azdır (7). Akut iskemik inmeli hastaların yaklaşık üçte biri erken nörolojik kötüleşme yaşamaktadır (8).…”