The association between neutrophil counts and neutrophil-to-lymphocyte ratio and stress hyperglycemia in patients with acute ischemic stroke according to stroke etiology

Abstract

Background and purposeStress hyperglycemia ratio (SHR), which is used to assess stress hyperglycemia, is associated with the functional outcome of ischemic stroke (IS). IS can induce the inflammatory response. Neutrophil counts and neutrophil-to-lymphocyte ratio (NLR) as good and easily available inflammatory biomarkers, the relationship between neutrophil counts and NLR and SHR were poorly explored in IS. We aimed to systemically and comprehensively explore the correlation between various blood inflammation markers (mainly neutrophil counts and NLR) and SHR.MethodsData from 487 patients with acute IS(AIS) in Xiangya Hospital were retrospectively reviewed. High/low SHR groups according to the median of SHR (≤1.02 versus >1.02). Binary logistic regression analysis was used to evaluate the correlation between neutrophil counts and NLR and high SHR group. Subgroup analyses were performed in the TOAST classification and functional prognosis.ResultsThe neutrophil counts and NLR were all clearly associated with SHR levels in different logistic analysis models. In the subgroup analysis of TOAST classification, the higher neutrophil counts and NLR were the independent risk factors for high SHR patients with large-artery atherosclerosis (LAA) (neutrophil: adjusted OR:2.047, 95% CI: 1.355-3.093, P=0.001; NLR: adjusted OR:1.315, 95% CI: 1.129-1.530, P<0.001). The higher neutrophil counts were the independent risk factor for high SHR patients with cardioembolism (CE) (adjusted OR:2.413, 95% CI: 1.081-5.383, P=0.031). ROC analysis showed that neutrophil counts was helpful for differentiating high SHR group with CE and low SHR group with CE (neutrophil: AUC =0.776, P=0.002). However, there were no difference in levels of neutrophil counts and NLR between patients with SVO and without SVO. The higher neutrophil counts and NLR independently associated with high SHR patients with mRS ≤2 at 90 days from symptom onset, (neutrophil: adjusted OR:2.284, 95% CI: 1.525-3.420, P<0.001; NLR: adjusted OR:1.377, 95% CI: 1.164-1.629, P<0.001), but not in patients with mRS >2.ConclusionsThis study found that the neutrophil counts and NLR are positively associated with SHR levels in AIS patients. In addition, the correlation between neutrophil counts and NLR and different SHR levels are diverse according to TOAST classification and functional prognosis.

Dynamic change of neutrophil‐to‐lymphocyte ratio and its predictive value of prognosis in acute ischemic stroke

“…Several previous studies have demonstrated the association of NLR with unfavorable functional outcomes in AIS (Chen et al., 2020 ), acute intracerebral ICH (Zhang et al., 2023 ), and subarachnoid hemorrhage (Oliveira & Rabelo, 2023 ). It has been reported that high neutrophil counts have been found at various stages of atherosclerosis, which could damage endothelial cells (Feng et al., 2023 ). In addition, inflammation represented by NLR was also closely related with a number of vascular risk factors, including diabetes (Dung et al., 2024 ), hypertension (Xu et al., 2023 ), and hyperlipidemia (Hashemi Moghanjoughi et al., 2022 ).…”

Update on Biomarkers Associated with Large-Artery Atherosclerosis Stroke

“…A retrospective Chinese study that included 487 patients with acute IS found that NLR and higher neutrophil counts were independently associated with the high stress hyperglycemia ratio in patients with LAA stroke [ 31 ]. SHR is used to assess stress hyperglycemia which is associated with the functional prognosis of IS [ 31 ].…”

“…A retrospective Chinese study that included 487 patients with acute IS found that NLR and higher neutrophil counts were independently associated with the high stress hyperglycemia ratio in patients with LAA stroke [ 31 ]. SHR is used to assess stress hyperglycemia which is associated with the functional prognosis of IS [ 31 ]. The authors speculate that stress hyperglycemia may promote the progression of atherosclerosis by activating peripheral blood lymphocytes and neutrophils and disrupting the blood–brain barrier in IS patients with LAA [ 31 ].…”

“…SHR is used to assess stress hyperglycemia which is associated with the functional prognosis of IS [ 31 ]. The authors speculate that stress hyperglycemia may promote the progression of atherosclerosis by activating peripheral blood lymphocytes and neutrophils and disrupting the blood–brain barrier in IS patients with LAA [ 31 ].…”

Stress, Hyperglycemia, and Insulin Resistance Correlate With Neutrophil Activity and Impact Acute Myocardial Infarction Outcomes

“…Stress-induced hyperglycemia significantly influences neutrophil function, enhancing and impairing their activities over time. Initially, high glucose levels boost neutrophil functions that include chemotaxis, phagocytosis, radical oxygen species, and neutrophil extracellular traps (NETs) production [ 17 , 18 ]. Prolonged hyperglycemia results in neutrophil dysfunction manifested by the exacerbation of inflammatory mechanisms while simultaneously diminishing reparative processes of the myocardium [ 19 - 23 ].…”