Introduction: The neutrophil to lymphocyte ratio (NLR) can be used as a marker of subclinical inflammation, and may have a predictive power in prognosis and severity of atherosclerosis-related diseases. This study aimed to assess an association between the NLR, and clinical characteristics and one-month outcome in acute ischemic stroke (AIS). Subjects and Methods: This case-control observational prospective study included 75 patients admitted to stroke unit of Ain Shams University hospitals with AIS, sub grouped into 3 equal groups according to subtype of AIS, in addition to 25 healthy individuals. The demographic characteristics of the patients, complete blood picture test results at presentation, National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores were recorded. The clinical outcome was assessed by the NIHSS and mRS scores after one month. Results: The total leucocyte count was significantly higher in large artery atherosclerosis (P = 0.004) and cardioembolic (P = 0.020) stroke groups, unlike lacunar stroke group (P = 0.082), when compared to controls. The neutrophils count was higher (P < 0.001) and the lymphocyte count was lower (P < 0.001) among all the stroke groups compared to the control group. The NLR was higher among all the stroke groups compared to the control group (P < 0.001). The NLR at cutoff value more than 1.34 had predicted stroke with a sensitivity of 89.33% and specificity of 72% and accuracy reached 88.6%. There was non-significant association between NLR and each of NIHSS and mRS after one month from onset of AIS. Conclusion: NLR was significantly higher among AIS subtypes compared to controls, but not a good predictor for one month outcome.
References
[1]
Wang, X. (2014) Neutrophil to Lymphocyte Ratio in Relation to Risk of All-Cause Mortality and Cardiovascular Events among Patients Undergoing Angiography or Cardiac Revascularization: A Meta-Analysis of Observational Studies. Atherosclerosis, 234, 206-213. https://doi.org/10.1016/j.atherosclerosis.2014.03.003
[2]
Papa, A., Emdin, M., Passino, C., et al. (2009) Predictive Value of Elevated Neutrophil-Lymphocyte Ratio on Cardiac Mortality in Patients with Stable Coronary Artery Disease. Clinica Chimica Acta, 395, 27-31.
https://doi.org/10.1016/j.cca.2008.04.019
[3]
Adams, H.P., Bendixen, B.H., Kappelle, L.J., et al. (1993) Classification of Subtype of Acute Ischemic Stroke. Definitions for Use in a Multicenter Clinical Trial. Stroke, 24, 35-41. https://doi.org/10.1161/01.STR.24.1.35
[4]
Tokgoz, S., Kayrak, M., Akpinar, Z., et al. (2013) Neutrophil Lymphocyte Ratio as a Predictor of Stroke. Journal of Stroke & Cerebrovascular Diseases, 22, 1169-1174.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.01.011
[5]
Kumar, A.D., Boehme, A.K., Siegler, J.E., et al. (2013) Leukocytosis in Patients with Neurologic Deterioration after Acute Ischemic Stroke Is Associated with Poor Outcomes. Journal of Stroke & Cerebrovascular Diseases, 22, 111-117.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.08.008
[6]
Saliba, W., Barnett-Griness, O., Elias, M., et al. (2015) Neutrophil to Lymphocyte Ratio and Risk of a First Episode of Stroke in Patients with Atrial Fibrillation: A Cohort Study. Journal of Thrombosis and Haemostasis, 13, 1971-1980.
https://doi.org/10.1111/jth.13006
[7]
Elkind, S. (2006) Inflammation, Atherosclerosis, and Stroke. The Neurologist, 12, 140-148. https://doi.org/10.1097/01.nrl.0000215789.70804.b0
[8]
Megens, R.T., Vijayan, S., Lievens, D., et al. (2012) Presence of Luminal Neutrophil Extracellular Traps in Atherosclerosis. Trends in Immunology, 30, 538-546.
[9]
Elkind, M.S.V., Sciacca, R.R., Boden-Albala, B., et al. (2005) Relative Elevation in Baseline Leukocyte Count Predicts First Cerebral Infarction. Neurology, 64, 2121-2125. https://doi.org/10.1212/01.WNL.0000165989.12122.49
[10]
Guven, H., Çilliler, A.E., Sarikaya, S.A., et al. (2010) Erken Lökosit ve Nötrofil Yüksekliğinin Akut skemik nmede Etyolojik ve Prognostik Önemi. Journal of the Neurological Sciences (Turk), 27, 311-318.
[11]
Rodriguez-Yanez, M. and Castillo, J. (2008) Role of Inflammatory Markers in Brain Ischemia. Current Opinion in Neurology, 21, 353-357.
https://doi.org/10.1097/WCO.0b013e3282ffafbf
[12]
Azab, B., Zaher, M., Weiserbs, K.F., et al. (2010) Usefulness of Neutrophil to Lymphocyte Ratio in Predicting Short- and Long-Term Mortality after Non-ST-Elevation Myocardial Infarction. American Journal of Cardiology, 106, 470-476.
https://doi.org/10.1016/j.amjcard.2010.03.062
[13]
Chavan, V., Patil, N. and Karnik, N.D. (2007) Study of Leukocytic Hydrolytic Enzymes in Patients with Acute Stage of Coronary Heart Disease. Indian Journal of Medical Sciences, 61, 73-82. https://doi.org/10.4103/0019-5359.30347
[14]
Kraft, P., Drechsler, C., Schuhmann, M.K., et al. (2015) Characterization of Peripheral Immune Cell Subsets in Patients with Acute and Chronic Cerebrovascular Disease: A Case Control Study. International Journal of Molecular Sciences, 16, 25433-25449. https://doi.org/10.3390/ijms161025433
[15]
Anzai, A., Anzai, T., Nagai, S., et al. (2012) Regulatory Role of Dendritic Cells in Post Infarction Healing and Left Ventricular Remodeling. Circulation, 125, 1234-1245. https://doi.org/10.1161/CIRCULATIONAHA.111.052126
[16]
Gökhan, S., Ozhasenekler, A., Durgun, M.H., et al. (2013) Neutrophil Lymphocyte Ratios in Stroke Subtypes and Transient Ischemic Attack. European Review for Medical and Pharmacological Sciences, 17, 653-657.
[17]
Ugur, L. and Umut, G. (2016) The Predictive Effect of the Neutrophil-to-Lymphocyte Ratio (NLR) on the Mortality of Acute Ischemic Stroke and Its Subtypes: A Retrospective Cross-Sectional Study. Eurasian Journal of Emergency Medicine, 15, 69-72.
https://doi.org/10.5152/eajem.2016.39974
