Neutrophil-to-lymphocyte ratio predicts early worsening in stroke due to large vessel disease

Abstract

Background Inflammation plays an important role in atherosclerosis and its complications. Since a dysregulated inflammatory response is associated with early neurological deterioration (END), serum neutrophil-to-lymphocyte ratio (NLR) could be a marker of END as well. Aim In this study, we evaluated the relationship between the serum NLR and END in patients with ischemic stroke due to large-artery atherosclerosis (LAA). Methods We evaluated consecutive patients with ischemic stroke due to LAA between January 2010 and December 2015. END was defined as an increase ≥ 2 on the total NIHSS score or ≥ 1 on the motor NIHSS score within the first 72 hours of admission. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Results Of the 349 included patients, 18.1% (n = 63) had END events. In multivariate analysis, serum NLR was independently associated with END (adjusted odds ratio, 1.08; 95% confidence interval [1.00–1.16], P = 0.043). Time to admission, and in-situ thrombosis and artery-to-artery embolization mechanisms were also significantly associated with END events. In an analysis of the relationship between serum NLR and vascular lesion burden, serum NLR was positively correlated with both the degree of stenotic lesions ( P for trend = 0.006) and the number of vessel stenosis ( P for trend = 0.038) in a dose-response manner. We also compared serum NLR by the stroke mechanisms: patients with hypoperfusion or in-situ thrombosis had the highest levels of NLR: however, only those with in-situ thrombosis had significantly higher NLR in the END group compared to the non-END group ( P = 0.005). Conclusions Serum NLR levels were associated with END events in patients with ischemic stroke due to LAA. Since NLR was also closely correlated with the underlying vascular lesions, our results indicated clues for mechanisms of END events.

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

“…In the subgroup analysis according to the type of stroke, there were three studies on hemorrhagic stroke [ 19 , 20 , 22 ], including 830 patients, of whom 237 developed END, and six studies on ischemic stroke [ 15 – 18 , 21 , 23 ], including 1894 patients, of whom 505 developed END. 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).…”

“…After screening of the remaining 17 studies in full text, three studies without any data on NLR and END, two studies with missing SD data, one study including stroke patients suffering from cancer, one study without a control group, and one review article were excluded. Finally, nine articles were included in our study [15][16][17][18][19][20][21][22][23] (Figure 1).…”

“…By extension, NLR may be a predictor of END in stroke patients. Several studies have found that an elevated NLR is related to the development of END [15][16][17][18][19][20][21][22][23]. 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, with no restrictions on the language or publication date, to analyze the potential of NLR as an END risk predictor.…”

The value of diffusion weighted imaging-alberta stroke program early CT score in predicting stroke-associated pneumonia in patients with acute cerebral infarction: a retrospective study

“…The clinical data collection included prior medical history (hypertension, diabetes mellitus, and atrial fibrillation), result of routine blood test, partial blood biochemical examination (levels of glucose, lipids, albumin, homocysteine, C-reactive protein, serum amyloid A), head MRI, chest X-ray photographs or pulmonary CT, and NIHSS at admission. The neutrophil-to-lymphocyte ratio (NLR), known as a systemic inflammation and infection mark, has shown an excellent power for predicting pneumonia ( Curbelo et al, 2017 ; Lee et al, 2016 ; Nam et al, 2019 ). Thus, we also evaluated the impact of NLR, as well as neutrophil-to-monocyte ratio (NMR), on patients with SAP.…”

A Systematic Review of Body Fluids Biomarkers Associated With Early Neurological Deterioration Following Acute Ischemic Stroke

“…Nam et al reported that NLR level was independently associated with END events in patients with LAAS. The mechanism might be involved in the degree of large artery stenosis, the number of stenotic lesions, and the stability of atherosclerotic plaque ( Nam et al, 2019 ). The NLR level was also related to END in patients with single subcortical infarctions which were defined as an infarct in the area of penetrating arteries and its prognosis is relatively favorable ( Nam et al, 2021 ).…”