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Kaleem S, Zhang C, Gusdon AM, Oh S, Merkler AE, Avadhani R, Awad I, Hanley DF, Kamel H, Ziai WC, Murthy SB. Association Between Neutrophil-Lymphocyte Ratio and 30-Day Infection and Thrombotic Outcomes After Intraventricular Hemorrhage: A CLEAR III Analysis. Neurocrit Care 2024; 40:529-537. [PMID: 37349600 DOI: 10.1007/s12028-023-01774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Serum neutrophil-lymphocyte ratio (NLR) is a surrogate marker for the inflammatory response after intracerebral hemorrhage (ICH) and is associated with perihematomal edema and long-term functional outcomes. Whether NLR is associated with short-term ICH complications is poorly understood. We hypothesized that NLR is associated with 30-day infection and thrombotic events after ICH. METHODS We performed a post hoc exploratory analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage III trial. The study exposure was the serum NLR obtained at baseline and on days 3 and 5. The coprimary outcomes, ascertained at 30 days, were any infection and a thrombotic event, defined as composite of cerebral infarction, myocardial infarction, or venous thromboembolism; both infection and thrombotic event were determined through adjudicated adverse event reporting. Binary logistic regression was used to study the relationship between NLR and outcomes, after adjustment for demographics, ICH severity and location, and treatment randomization. RESULTS Among the 500 patients enrolled in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage III trial, we included 303 (60.6%) without missing data on differential white blood cell counts at baseline. There were no differences in demographics, comorbidities, or ICH severity between patients with and without data on NLR. In adjusted logistic regression models, NLR ascertained at baseline (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.01-1.07, p = 0.03) and NLR ascertained at day 3 were associated with infection (OR 1.15; 95% CI 1.05-1.20, p = 0.001) but not with thrombotic events. Conversely, NLR at day 5 was associated with thrombotic events (OR 1.07, 95% CI 1.01-1.13, p = 0.03) but not with infection (OR 1.13; 95% CI 0.76-1.70, p = 0.56). NLR at baseline was not associated with either outcome. CONCLUSIONS Serum NLR ascertained at baseline and on day 3 after randomization was associated with 30-day infection, whereas NLR obtained on day 5 was associated with thrombotic events after ICH, suggesting that NLR could be a potential early biomarker for ICH-related complications.
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Affiliation(s)
- Safa Kaleem
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Aaron M Gusdon
- Department of Neurological Surgery, University of Texas Health Science Center, Houston, TX, USA
| | - Stephanie Oh
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Radhika Avadhani
- Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Isaam Awad
- Department of Neurological Surgery, University of Chicago School of Medicine, Chicago, IL, USA
| | - Daniel F Hanley
- Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Wendy C Ziai
- Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurological Surgery, University of Chicago School of Medicine, Chicago, IL, USA
| | - Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
- Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Huang J, Liao F, Luo Y, Shu X. Neutrophil-to-lymphocyte ratio at admission is a risk factor for in-hospital gastrointestinal bleeding in acute ischemic stroke patients after dual antiplatelet therapy: A case control study. J Stroke Cerebrovasc Dis 2023; 32:107325. [PMID: 37660552 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Gastrointestinal bleeding is a clinically important complication in acute ischemic stroke patients after dual antiplatelet therapy. The present study was to explore the association between neutrophil-to-lymphocyte ratio (NLR) and in-hospital gastrointestinal bleeding in acute ischemic stroke (AIS) patients who had received dual antiplatelet therapy. METHODS This restrospective study enrolled AIS patients who had received dual antiplatelet therapy in our hospital from January 2019 to December 2021. Patients were divided into a bleeding group and a non-bleeding group according to whether they had in-hospital gastrointestinal bleeding. Propensity score matching was used to match the confounding variables between the two groups. Multivariate logistic regression was performed to evaluate the association between NLR and in-hospital gastrointestinal bleeding. Receiver operating characteristic (ROC) curve was used to test the prediction ability of NLR. RESULTS A total of 1130 patients were enrolled in this study. Before matching, there were 51 patients in the bleeding group, 1079 patients in the non-bleeding group. After matching, 49 pairs of patients were successfully matched. Multivariate regression revealed that NLR was an independent predictor of in-hospital gastrointestinal bleeding in AIS patients who had received dual antiplatelet therapy. The area under curve (AUC) of NLR in predicting in-hospital gastrointestinal bleeding was 0.908, the sensitivity and specificity were 0.878 and 0.857 respectively. CONCLUSIONS NLR at admission is a useful predictor of in-hospital gastrointestinal bleeding in acute ischemic stroke patients after dual antiplatelet therapy. Still, more prospective studies with larger sample size are needed to validate the result.
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Affiliation(s)
- Jiaming Huang
- Department of Gastroenterology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, China.
| | - Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yeting Luo
- Department of Neurology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, China
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
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Admission neutrophil-to-lymphocyte ratio predicts length of hospitalization and need for ICU admission in adults with Status Epilepticus. Seizure 2023; 106:80-84. [PMID: 36803830 DOI: 10.1016/j.seizure.2023.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Status epilepticus (SE) is a time-dependent neurological emergency. The current study evaluated the prognostic value of admission neutrophil-to-lymphocyte ratio (NLR) in patients with status epilepticus. METHODS In this retrospective observational cohort study we included all consecutive patients discharged from our neurology unit with the clinical or EEG diagnosis of SE from 2012 to 2022. Stepwise multivariate analysis was conducted to test the association of NLR with length of hospitalization, need for Intensive Care Unit (ICU) admission and 30 days mortality. Receiver operating characteristic (ROC) analysis was performed to identify the best cutoff for NLR to identify patients who will need ICU admission. RESULTS A total of 116 patients were enrolled in our study. NLR was correlated with length of hospitalization (p = 0.020) and need for ICU admission ( p = 0.046). In addition, the risk of ICU admission increased in patients with intracranial hemorrhage and length of hospitalization was correlated with C-reactive protein-to-albumin ratio (CRP/ALB). ROC analysis identified a NLR of 3.6 as best cutoff value to discriminate need of ICU admission (area under the curve [AUC]=0.678; p = 0.011; Youden's index=0.358; sensitivity, 90.5%, specificity, 45.3%). DISCUSSION In patients with SE admission NLR could be a predictor of length of hospitalization and need for ICU admission.
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Kim MS, Heo MY, Joo HJ, Shim GY, Chon J, Chung SJ, Soh Y, Yoo MC. Neutrophil-to-Lymphocyte Ratio as a Predictor of Short-Term Functional Outcomes in Acute Ischemic Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:898. [PMID: 36673655 PMCID: PMC9859224 DOI: 10.3390/ijerph20020898] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
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.
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Affiliation(s)
| | | | | | | | | | | | - Yunsoo Soh
- Correspondence: (Y.S.); (M.C.Y.); Tel.: +82-2-958-8980 (M.C.Y.); Fax: +82-2-958-8470 (M.C.Y.)
| | - Myung Chul Yoo
- Correspondence: (Y.S.); (M.C.Y.); Tel.: +82-2-958-8980 (M.C.Y.); Fax: +82-2-958-8470 (M.C.Y.)
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Liu Y, Li G, Jia J, Liu X, Guo J, Zhao X. Clinical significance of neutrophil to lymphocyte ratio in ischemic stroke and transient ischemic attack in young adults. BMC Neurol 2022; 22:481. [DOI: 10.1186/s12883-022-03011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Objective
Few studies evaluated the association between neutrophil to lymphocyte ratio (NLR) and clinical outcomes in ischemic stroke or transient ischemia attack (TIA) in young adults. We aimed to investigate the relationship of NLR with 90-day functional independence in ischemic stroke or TIA in young adults.
Methods
We retrospectively included patients aged 18–45 and diagnosed with ischemic stroke or TIA. Information including demographics, clinical and imaging characteristics, and the 90-day clinical outcome was collected. The primary outcome was excellent clinical outcome at 90 days, defined as mRS 0–1. Logistic regression analyses and a receiver operator characteristic (ROC) curve were used to investigate the association between NLR and 90-day clinical outcome.
Results
A total of 691 young patients with ischemic stroke or TIA were included in the final study. A higher level of NLR indicated poorer clinical outcome at 90 days (p for trend <0.001). The multivariable logistics regression suggested that NLR was an independent predictor of mRS 0–1 at 90 days (crude OR: 0.88, 95% CI 0.83–0.94, p < 0.001; adjusted OR of model 2: 0.87, 95% CI 0.84–0.94, p < 0.001; adjusted OR of model 3: 0.92, 95% CI 0.84–0.99, p = 0.04).
Conclusion
In our study, a higher level of NLR was correlated with poorer functional outcomes at 90 days in ischemic stroke or TIA in young adults.
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Zhai M, Cao S, Wang X, Liu Y, Tu F, Xia M, Li Z. Increased neutrophil-to-lymphocyte ratio is associated with unfavorable functional outcomes in acute pontine infarction. BMC Neurol 2022; 22:445. [PMID: 36447170 PMCID: PMC9707260 DOI: 10.1186/s12883-022-02969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) is positively associated with unfavorable outcomes in patients with cerebral infarction. This study aimed to investigate the relationship between the NLR and the short-term clinical outcome of acute pontine infarction. METHODS Patients with acute pontine infarction were consecutively included. Clinical and laboratory data were collected. All patients were followed up at 3 months using modified Rankin Scale (mRS) scores. An unfavorable outcome was defined as an mRS score ≥ 3. Receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cutoff values for patients with acute pontine infarction. risk factors can be predictive factors for an unfavorable outcome after acute pontine infarction. RESULTS Two hundred fifty-six patients with acute pontine infarction were included in this study. The NLR was significantly higher in the unfavorable outcome group than in the favorable outcome group (P < 0.05). Additionally, the infarct size was significantly higher in the high NLR tertile group than in the low NLR tertile group (P < 0.05). Multivariate logistic regression analysis revealed that the baseline National Institutes of Health Stroke Scale (NIHSS) score, NLR, platelet count, and fasting blood glucose (FBG) level were significantly associated with unfavorable outcomes 3 months after acute pontine infarction. The optimal cutoff value of the NLR for predicting the 3-month outcome of acute pontine infarction was 3.055. The negative and positive predictive values of NLR were 85.7% and 61.3%, respectively, and the sensitivity and specificity of NLR were 69.2% and 80.9%. CONCLUSIONS We found that the NLR may be an independent predictive factor for the outcome of acute pontine infarction.
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Affiliation(s)
- Mingfeng Zhai
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Fuyang People’s Hospital of Anhui Medical University, The People’s Hospital of Fuyang, Fuyang, 236300 China
| | - Shugang Cao
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Hefei Hospital of Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, China
| | - Xinlin Wang
- grid.16821.3c0000 0004 0368 8293Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Liu
- grid.252957.e0000 0001 1484 5512Department of Neurology, The Affiliated Fuyang Hospital of Bengbu Medical College, Fuyang, China
| | - Feng Tu
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Fuyang People’s Hospital of Anhui Medical University, The People’s Hospital of Fuyang, Fuyang, 236300 China
| | - Mingwu Xia
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Hefei Hospital of Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, China
| | - Zongyou Li
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Fuyang People’s Hospital of Anhui Medical University, The People’s Hospital of Fuyang, Fuyang, 236300 China ,grid.252957.e0000 0001 1484 5512Department of Neurology, The Affiliated Fuyang Hospital of Bengbu Medical College, Fuyang, China
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Feng Y, Bai X, Li W, Cao W, Xu X, Yu F, Fu Z, Tian Q, Guo X, Wang T, Sha A, Chen Y, Gao P, Wang Y, Chen J, Ma Y, Chen F, Dmytriw AA, Regenhardt RW, Lu J, Ma Q, Yang B, Jiao L. Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy. Front Immunol 2022; 13:963111. [PMID: 36275640 PMCID: PMC9585914 DOI: 10.3389/fimmu.2022.963111] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Only approximately half of anterior circulation large vessel occlusion (LVO) patients receiving endovascular treatment (EVT) have a favorable outcome. The aim of this study was to explore the association of dynamic inflammatory markers (i.e., neutrophil to lymphocyte ratios, NLR, measured at different times after EVT) as well as other potential influencing factors with unfavorable outcome among acute ischemic stroke (AIS) patients who achieved complete reperfusion after EVT. Methods Patients treated with EVT for LVO between January 2019 to December 2021 were prospectively enrolled. Complete reperfusion was defined as modified thrombolysis in cerebral infarction (mTICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3-6 was defined as unfavorable outcome (i.e., futile reperfusion). A logistic regression analysis was performed with unfavorable outcome as a dependent variable. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were then used to determine the diagnostic values of NLR and other relevant factors. Results 170 patients with complete reperfusion (mTICI 3) were included in this study. Unfavorable outcome was observed in 70 (41.2%). Higher NLR within 24h (p=0.017) and at 3-7d (p=0.008) after EVT were an independent risk factors for unfavorable outcome at 3 months. In addition, older age, higher NIHSS scores, poor collaterals, and general anesthesia were independent predictors of unfavorable outcomes. When accounting for NLR, the diagnostic efficiency improved compared to conventional characteristics. Conclusion Our findings suggest that advanced age, increased stroke severity, poor collaterals, general anesthesia, and NLR are independent predictors for an unfavorable clinical outcome following complete reperfusion after EVT. Neuroinflammation may merit particular attention in future studies.
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Affiliation(s)
- Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Wei Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Liaocheng Brain Hospital, Liaocheng, China
| | - Wenbo Cao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xin Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Fan Yu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Zhaolin Fu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xiaofan Guo
- Department of Neurology, Loma Linda University Health, Loma Linda, CA, United States
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Arman Sha
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Fei Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Li S, Hu L, Wang J, Zou F, Han B, Wang Y, Liu K. Prolonged increased neutrophil-to-lymphocyte ratio is associated with mortality after successful revascularization for treatment of acute ischemic stroke. BMC Neurol 2022; 22:326. [PMID: 36045323 PMCID: PMC9429692 DOI: 10.1186/s12883-022-02847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background To determine the association between dynamic neutrophil-to-lymphocyte ratio (NLR) during hospitalization and mortality 1 month after ischemia reperfusion in patients undergoing endovascular treatment (EVT) with successful revascularization for acute large vessel occlusion stroke. Methods This retrospective study included patients who had undergone successful EVT. Information was collected regarding patients’ clinical characteristics, imaging data, and mortality at 1 month. Univariate and multivariate logistic regression models were applied to assess the association between NLR and mortality. We used a generalized additive model and a generalized additive mixed model to compare trends in NLR over time between survivors and nonsurvivors. Results A total of 237 patients were included. During the 1-month follow-up, 42 of these patients (17.7%) died. The multivariate analysis demonstrated that NLR obtained within 12 to 24 hours (odds ratio [OR] = 1.18; 95% confidence interval [CI]: 1.04, 1.33; P = 0.008), 24 to 48 hours (OR = 1.16; 95% CI: 1.01, 1.35; P = 0.044), and 48 to 72 hours (OR = 1.23; 95% CI: 1.03, 1.47; P = 0.021) after EVT were independently associated with mortality at 1 month. In addition, there was a trend for NLR to decrease gradually over time for both survivors and nonsurvivors; however, NLR in survivors decreased by an average of 0.29 daily than in nonsurvivors. Conclusions Increased NLR in the early period after EVT was associated with an increased risk of mortality, and a continued trend toward higher NLR over time was also linked with a higher mortality risk.
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He J, Xue K, Liu J, Gu JH, Peng B, Xu L, Wang G, Jiang Z, Li X, Zhang Y. Timely and Appropriate Administration of Inhaled Argon Provides Better Outcomes for tMCAO Mice: A Controlled, Randomized, and Double-Blind Animal Study. Neurocrit Care 2022; 37:91-101. [PMID: 35137354 DOI: 10.1007/s12028-022-01448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inhaled argon (iAr) has shown promising therapeutic efficacy for acute ischemic stroke and has exhibited impressive advantages over other inert gases as a neuroprotective agent. However, the optimal dose, duration, and time point of iAr for acute ischemic stroke are unknown. Here, we explored variable iAr schedules and evaluated the neuroprotective effects of acute iAr administration on lesion volume, brain edema, and neurological function in a mouse model of cerebral ischemic/reperfusion injury. METHODS Adult ICR (Institute of Cancer Research) mice were randomly subjected to sham, moderate (1.5 h), or severe (3 h) transient middle cerebral artery occlusion (tMCAO). One hour after tMCAO, the mice were randomized to variable iAr protocols or air. General and focal deficit scores were assessed during double-blind treatment. Infarct volume, overall recovery, and brain edema were analyzed 24 h after cerebral ischemic/reperfusion injury. RESULTS Compared with those in the tMCAO-only group, lesion volume (p < 0.0001) and neurologic outcome (general, p < 0.0001; focal, p < 0.0001) were significantly improved in the group administered iAr 1 h after stroke onset (during ischemia). Short-term argon treatment (1 or 3 h) significantly improved the infarct volume (1 vs. 24 h, p < 0.0001; 3 vs. 24 h, p < 0.0001) compared with argon inhalation for 24 h. The concentration of iAr was confirmed to be a key factor in improving focal neurological outcomes relative to that in the tMCAO group, with higher concentrations of iAr showing better effects. Additionally, even though ischemia research has shown an increase in cerebral damage proportional to the ischemia time, argon administration showed significant neuroprotective effects on infarct volume (p < 0.0001), neurological deficits (general, p < 0.0001; focal, p < 0.0001), weight recovery (p < 0.0001), and edema (p < 0.0001) in general, particularly in moderate stroke. CONCLUSIONS Timely iAr administration during ischemia showed optimal neurological outcomes and minimal infarct volumes. Moreover, an appropriate duration of argon administration was important for better neuroprotective efficacy. These findings may provide vital guidance for using argon as a neuroprotective agent and moving to clinical trials in acute ischemic stroke.
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Affiliation(s)
- Juan He
- Stroke Center and Department of Neurology, Affiliated Hospital of Nantong University, Nantong, 226019, Jiangsu, China
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China
| | - Ke Xue
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China
| | - Jiayi Liu
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China
| | - Jin-Hua Gu
- Stroke Center and Department of Neurology, Affiliated Hospital of Nantong University, Nantong, 226019, Jiangsu, China
| | - Bin Peng
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China
| | - Lihua Xu
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China
| | - Guohua Wang
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China
| | - Zhenglin Jiang
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China
| | - Xia Li
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China.
| | - Yunfeng Zhang
- Stroke Center and Department of Neurology, Affiliated Hospital of Nantong University, Nantong, 226019, Jiangsu, China.
- Institute of Special Environmental Medicine and Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, Jiangsu, China.
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Zhao Y, Zhang S, Yi Y, Qu T, Gao S, Lin Y, Zhu H. Neutrophil-to-lymphocyte ratio as a predictor for cardiovascular diseases: a cohort study in Tianjin, China. J Hum Hypertens 2022:10.1038/s41371-022-00724-7. [PMID: 35859165 DOI: 10.1038/s41371-022-00724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
Based on a cohort in Tianjin, China, we explore the relationship between neutrophils-to-lymphocyte ratio (NLR) and the risk of cardiovascular diseases (CVDs). From January 2010 to December 2019, 4667 eligible participants aged more than 40 years old, CVDs-free, and registered in two community health service centers were recruited and followed up. The values of NLR collected at baseline were included in Cox proportional hazards model to evaluate its association with the incidence risk of CVDs. Hazard ratio (HR) and 95% confidence interval (CI) were calculated before and after adjustment for potential confounding factors selected by LASSO regression. During a total of 13,691 person-years of follow-up among all participants (median, 2.0 years; interquartile range, 1.7-2.5), 150 (3.42%) newly diagnosed CVDs events occurred, with the incidence density of CVDs of 10.96/1000 person-year. The incidence density in subgroups categorized by tertiles of baseline NLR was 8.08/1000, 11.74/1000, and 13.24/1000, respectively (p trend = 0.019). COX models revealed that after adjustment for potential confounders, NLR (as a continuous variable) was significantly related to the risk of total CVDs (HR 1.10, 95% CI: 1.04, 1.17), myocardial infarction (HR 1.12, 95% CI: 1.05, 1.20), and ischemic stroke (HR 1.21, 95% CI: 1.10, 1.33). When NLR was categorized into tertiles, participants in the top tertile had a significantly higher risk of CVDs (HR 1.61, 95% CI: 1.06, 2.44) and myocardial infarction (HR 1.88, 95% CI: 1.09, 3.27) relative to those in the bottom tertile.
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Affiliation(s)
- Yuxin Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Shuaixiang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Yue Yi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Ting Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Si Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Yizhou Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Hong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China. .,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China.
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11
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Li L, Zhang H, Feng GL. Neutrophil-to-lymphocyte ratio predicts in-hospital mortality in intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2022; 31:106611. [PMID: 35780721 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106611] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/06/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The neutrophil-to-lymphocyte ratio is gaining popularity as a low-cost biomarker of inflammation and outcome prediction. Intracerebral hemorrhage has high mortality and disability, which strongly influences societal development. This study aimed to research whether the neutrophil-to-lymphocyte ratio can predict hospital mortality in patients with severe intracerebral hemorrhage. MATERIALS AND METHODS It was a retrospective analysis of prospectively collected data. The survival analysis and proportional hazards models analyzed clinical data from the Medical Information Mart for Intensive Care III database of patients with intracerebral hemorrhage. RESULTS The records of 1,000 patients were included in our study. Two hundred forty-seven individuals died in the hospital, while 753 survived to discharge. According to data analysis, the neutrophil-to-lymphocyte ratio of the death group (11.21±7.81) significantly exceeded the survival group (7.94±6.04). The univariate Cox regression revealed that the neutrophil-to-lymphocyte ratio is a potential predictor of in-hospital mortality (HR:1.044; 95% CI:1.029-1.059; p <0.001). Furthermore, the proportional hazards model demonstrated that the risk of in-hospital death increased 2.34-fold for each increase in neutrophil-to-lymphocyte ratio when other factors were held constant. Following the ROC analysis, the Kaplan-Meier based on the proportional hazards model showed that patients with a neutrophil-to-lymphocyte ratio >7.68 on the first day of hospitalization had a higher risk of death. CONCLUSIONS In patients with severe intracerebral hemorrhage, the neutrophil-to-lymphocyte ratio is a potential predictor of in-hospital mortality.
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Affiliation(s)
- Li Li
- Department of Emergency, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China.
| | - Hang Zhang
- Department of Gastroenterology, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China.
| | - Gui-Long Feng
- Department of Emergency, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China.
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12
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Khanzadeh S, Lucke-Wold B, Eshghyar F, Rezaei K, Clark A. The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis. DISEASE MARKERS 2022; 2022:1983455. [PMID: 35313569 PMCID: PMC8934208 DOI: 10.1155/2022/1983455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 02/08/2023]
Abstract
Ischemic and hemorrhagic strokes have multiple downstream consequences for patients. One of the most critical is poststroke infection (PSI). The goal of this systematic review and meta-analysis was to critically evaluate the literature regarding the use of the neutrophil to lymphocyte ratio (NLR) as a reliable means to detect early PSI development, particularly poststroke pneumonia (PSP) development to help clinicians institute early interventions and improve outcomes. The following were the inclusion criteria: (1) cross-sectional, case-control, and cohort studies; (2) studies comparing NLR data from PSI or PSP patients to controls; and (3) studies with a control group of stroke patients without infection. There was not any language or publication preference. The Newcastle-Ottawa Scale was used by two writers to assess the quality of the included studies. We assessed the certainty of the associations with GRADE methods. Web of Science, PubMed, and Scopus were searched, and 25 studies were included in the qualitative review. Among them, 15 studies were included in the meta-analysis. Standardized mean difference (SMD) was reported with a 95% confidence interval (CI) for the NLR levels. Patients with PSI had significantly higher NLR levels than stroke patients without infection (SMD = 1.08; CI 95% = 0.78-1.39, P value < 0.001). In addition, the NLR levels of the stroke patients with pneumonia were significantly higher than those without pneumonia (SMD = 0.98; CI 95% = 0.81-1.14, P value < 0.001). However, data extracted from the qualitative review suggested that NLR could not predict urinary tract infection, sepsis, or ventriculitis in stroke patients. Our study indicated that NLR could be recommended as an inexpensive biomarker for predicting infection, particularly pneumonia, in stroke patients. It can help clinicians institute early interventions that can reduce PSI and improve outcomes.
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Affiliation(s)
- Shokoufeh Khanzadeh
- 1Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Eshghyar
- 3Tehran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Katayoun Rezaei
- 4Student Research Committee, University of Kharazmi, Karaj, Iran
| | - Alec Clark
- 5University of Central Florida, School of Medicine, Orlando, USA
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Zou F, Wang J, Han B, Bao J, Fu Y, Liu K. Early Neutrophil-to-Lymphocyte Ratio Is a Prognostic Marker in Acute Ischemic Stroke After Successful Revascularization. World Neurosurg 2021; 157:e401-e409. [PMID: 34662658 DOI: 10.1016/j.wneu.2021.10.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To explore the association between early neutrophil-to-lymphocyte ratio (ENLR) and prognosis of anterior circulation large-vessel occlusion stroke (LVOS) after patients undergo endovascular treatment (EVT) with successful revascularization. METHODS Patients who experienced acute anterior circulation LVOS and underwent EVT at Changzhou Second People's Hospital Affiliated to Nanjing Medical University between May 2017 and May 2020 were included in this retrospective study. We collected information about patients' baseline characteristics, medical history, laboratory test results, imaging data, and endovascular treatment outcomes, as well as data from follow-up at 3 months. Univariate and multivariate logistic regression models were used to evaluate the association between ENLR and functional disease prognosis. A piecewise linear regression model was also applied to compute the threshold effect of ENLR on poor prognosis (defined as modified Rankin Scale score 3-6) at 3 months using a smoothing plot. RESULTS Of 224 patients who received EVT during the study period, 160 patients were included in the analysis. After adjustments were made for potential confounders, multivariate analysis demonstrated a significant association between ENLR and poor prognosis at 3 months (odds radio 1.19; 95% confidence interval 1.07-1.32; P = 0.0016). An ENLR ≥9.75 was found to be significantly associated with poor prognosis at 3 months (odds ratio 1.54; 95% confidence interval 1.19-2.00; P = 0.0119). CONCLUSIONS Increased ENLR after successful revascularization is independently associated with poor prognosis. These findings suggest that ENLR could be used to inform treatment strategies for patients who experience anterior circulation LVOS.
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Affiliation(s)
- Feihui Zou
- Department of Neurosurgery, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Jiangsu, Changzhou, China
| | - Jian Wang
- Department of Neurosurgery, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Jiangsu, Changzhou, China
| | - Bin Han
- Department of Neurosurgery, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Jiangsu, Changzhou, China
| | - Jiannan Bao
- Department of Neurosurgery, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Jiangsu, Changzhou, China
| | - Yin Fu
- Department of Neurosurgery, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Jiangsu, Changzhou, China
| | - Kefeng Liu
- Department of Neurosurgery, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Jiangsu, Changzhou, China.
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Yun S, Jun Yi H, Hoon Lee D, Hoon Sung J. Clinical significance of platelet to neutrophil ratio and platelet to lymphocyte ratio in patients with aneurysmal subarachnoid hemorrhage. J Clin Neurosci 2021; 92:49-54. [PMID: 34509261 DOI: 10.1016/j.jocn.2021.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/21/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Abstract
The aim of study was aimed to investigate associations of platelet-to-neutrophil ratio (PNR) and platelet-to-lymphocyte ratio (PLR) on admission with clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH). A retrospective analysis was performed on patients who were treated for aSAH. Unfavorable clinical outcome was defined as Modified Rankin Scale (mRS) score of 3-6 at 90-days. Receiver operating characteristic curve analysis was performed to detect optimal cutoff values of PNR and PLR for predicting clinical outcomes. Logistic regression was used to explore associations of PNR and PLR with clinical outcomes. A total of 544 patients with aSAH were enrolled. Of them, 152 (29.9%) had unfavorable clinical outcome. Optimal cutoff values of PNR and PLR to predict clinical outcomes at 90 days after aSAH were 25 and 130, respectively (P < 0.001 and <0.001, respectively). In multivariate logistic regression analysis, PNR <25 and PLR ≥ 130 were associated with unfavorable clinical outcome at 90 days after aSAH (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.23-3.69; P = 0.018 and OR: 1.56; 95% CI: 1.18-2.62; P = 0.031, respectively). PNR and PLR as novel inflammatory biomarkers could predict the clinical outcome after aSAH. PNR <22 and PLR ≥ 130 were associated with unfavorable clinical outcome at 90 days after aSAH.
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Affiliation(s)
- Seonyong Yun
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea; Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Jun Yi
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea; Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Dong Hoon Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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15
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Gao B, Pan W, Hu X, Huang H, Ren J, Yang C, Zhou X, Zeng T, Hu J, Li S, Gao Y, Zhang S, Chen G. Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis. Front Physiol 2021; 12:670323. [PMID: 34276399 PMCID: PMC8283126 DOI: 10.3389/fphys.2021.670323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose Mounting researches have illuminated that the neutrophil-related ratios were related to the prognosis of acute ischemic stroke (AIS). However, few have compared their predictive value and accuracy. To make such comparison and identify the best indicator on the 90-day outcome, we investigated biomarkers including neutrophil ratio (Nr), neutrophil count (Nc), lymphocyte (L), neutrophil-to-lymphocyte ratio (NLR), platelet (P or PLT), platelet-to-neutrophil ratio (PNR), NLR-to-platelet ratio (NLR/PLT), eosinophil (E), neutrophil-to-eosinophil ratio (NER), monocyte (M), and monocyte-to-neutrophil ratio (MNR). Methods This retrospective study recruited 283 AIS and 872 healthy controls (HCs) receiving intravenous thrombolysis (IVT). Blood samples were collected after 24 h of admission before IVT. Propensity Score Matching (PSM) was used to explore whether these ratios differentiated AIS and HCs. We applied univariate and multivariate analyses to evaluate the prediction effect of these ratios separately or added in the model and figured out a clinical prediction model. To estimate the discrimination and calibration of the new models, the receiver operating characteristics (ROC) curve analysis, DeLong method, and likelihood ratio test (LR test) were utilized. Results PSM showed that Nr, Nc, NLR, P, PNR, NLR/PLT, NER, and MNR facilitates the differentiation of the HCs and AIS. Among the eight biomarkers, PNR and MNR could differentiate the 90-day outcome, and it was found out that PNR performed better. Univariate regression analysis demonstrated that PNR was the only independent predictor which needs no adjustment. Besides, the multivariate regression analysis, Delong method, and LR test indicated that among the neutrophil-related ratios, NLR, PNR, NLR/PLT, NER, and MNR exerted little influence on the discrimination but could enhance the calibration of the base model, and NER proved to work best. Conclusion Low PNR was the best indicator among the neutrophil-related ratios tin predicting a poor 90-day outcome of AIS patients. Moreover, high NER performed best when predicting the 90-day outcome to improve the calibration of the base model.
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Affiliation(s)
- Beibei Gao
- Department of Internal Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenjing Pan
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xueting Hu
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Honghao Huang
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Junli Ren
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Chenguang Yang
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xinbo Zhou
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Tian Zeng
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jingyu Hu
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Shengqi Li
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yufan Gao
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Shunkai Zhang
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guangyong Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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16
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Neutrophil-to-lymphocyte ratio is associated with increased cerebral blood flow velocity in acute bacterial meningitis. Sci Rep 2021; 11:11383. [PMID: 34059730 PMCID: PMC8166920 DOI: 10.1038/s41598-021-90816-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/17/2021] [Indexed: 12/26/2022] Open
Abstract
In community-acquired bacterial meningitis (CABM) intracranial vascular alterations are devastating complications which are triggered by neuroinflammation and result in worse clinical outcome. The Neutrophil-to-Lymphocyte ratio (NLR) represents a reliable parameter of the inflammatory response. In this study we analyzed the association between NLR and elevated cerebral blood flow velocity (CBFv) in CABM-patients. This study included all (CABM)-patients admitted to a German tertiary center between 2006 and 2016. Patients’ demographics, in-hospital measures, neuroradiological data and clinical outcome were retrieved from institutional databases. CBFv was assessed by transcranial doppler (TCD). Patients’, radiological and laboratory characteristics were compared between patients with/without elevated CBFv. Multivariate-analysis investigated parameters independently associated with elevated CBFv. Receiver operating characteristic(ROC-)curve analysis was undertaken to identify the best cut-off for NLR to discriminate between increased CBFv. 108 patients with CABM were identified. 27.8% (30/108) showed elevated CBFv. Patients with elevated CBFv and normal CBFv, respectively had a worse clinical status on admission (Glasgow Coma Scale: 12 [9–14] vs. 14 [11–15]; p = 0.005) and required more often intensive care (30/30 [100.0%] vs. 63/78 [80.8%]; p = 0.01).The causative pathogen was S. pneumoniae in 70%. Patients with elevated CBFv developed more often cerebrovascular complications with delayed cerebral ischemia (DCI) within hospital stay (p = 0.031). A significantly higher admission-NLR was observed in patients with elevated CBFv (median [IQR]: elevated CBFv:24.0 [20.4–30.2] vs. normal CBFv:13.5 [8.4–19.5]; p < 0.001). Multivariate analysis, revealed NLR to be significantly associated with increased CBFv (Odds ratio [95%CI] 1.042 [1.003–1.084]; p = 0.036). ROC-analysis identified a NLR of 20.9 as best cut-off value to discriminate between elevated CBFv (AUC = 0.713, p < 0.0001, Youden's Index = 0.441;elevated CBFv: NLR ≥ 20.9 19/30[63.5%] vs. normal CBFv: NLR > 20.9 15/78[19.2%]; p < 0.001). Intracranial vascular complications are common among CABM-patients and are a risk factor for unfavorable outcome at discharge. Elevated NLR is independently associated with high CBFv and may be useful in predicting patients’ prognosis.
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Xie QJ, Huang W, Shen L, Wang MH, Liu KF, Liu F. Combination of Neutrophil-to-Lymphocyte Ratio and Admission Glasgow Coma Scale Score Is Independent Predictor of Clinical Outcome in Diffuse Axonal Injury. World Neurosurg 2021; 152:e118-e127. [PMID: 34033962 DOI: 10.1016/j.wneu.2021.05.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of clinical outcome of different diseases, such as acute ischemic stroke, intracerebral hemorrhage, malignant tumor, and traumatic brain injury. However, the prognostic value of NLR plus admission Glasgow Coma Scale score (NLR-GCS) is still unclear in patients with diffuse axonal injury (DAI). Therefore this study assessed the relationship between the NLR-GCS and 6-month outcome of DAI patients. METHODS The clinical characteristics of DAI patients admitted to our department between January 2014 and January 2020 were retrospectively analyzed. The candidate risk factors were screened by using univariate analysis, and the independence of resultant risk factors was evaluated by the binary logistic regression analysis and least absolute shrinkage and selection operator regression analysis. The predictive value of NLR-GCS in an unfavorable outcome was assessed by the receiver operating characteristics curve analysis. RESULTS A total of 93 DAI patients were included. Binary logistic regression analysis and least absolute shrinkage and selection operator regression analysis showed the level of NLR on admission was an independent risk factor of unfavorable outcomes in DAI patients. The ROC curve analysis showed that the predictive capacity of the combination of NLR and admission GCS score and combination of NLR and coma duration outperformed NLR, admission GCS score, and coma duration alone. CONCLUSIONS The higher NLR level on admission is independently associated with unfavorable outcomes of DAI patients at 6 months. Furthermore, the combination of NLR and admission GCS score provides the superior predictive capacity to either NLR or GCS alone.
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Affiliation(s)
- Qi-Jun Xie
- Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Wu Huang
- Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Liang Shen
- Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Ming-Hai Wang
- Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Ke-Feng Liu
- Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Fang Liu
- Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China.
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Krishnan S, O’Boyle C, Smith CJ, Hulme S, Allan SM, Grainger JR, Lawrence CB. A hyperacute immune map of ischaemic stroke patients reveals alterations to circulating innate and adaptive cells. Clin Exp Immunol 2021; 203:458-471. [PMID: 33205448 PMCID: PMC7874838 DOI: 10.1111/cei.13551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
Systemic immune changes following ischaemic stroke are associated with increased susceptibility to infection and poor patient outcome due to their role in exacerbating the ischaemic injury and long-term disability. Alterations to the abundance or function of almost all components of the immune system post-stroke have been identified, including lymphocytes, monocytes and granulocytes. However, subsequent infections have often confounded the identification of stroke-specific effects. Global understanding of very early changes to systemic immunity is critical to identify immune targets to improve clinical outcome. To this end, we performed a small, prospective, observational study in stroke patients with immunophenotyping at a hyperacute time point (< 3 h) to explore early changes to circulating immune cells. We report, for the first time, decreased frequencies of type 1 conventional dendritic cells (cDC1), haematopoietic stem and progenitor cells (HSPCs), unswitched memory B cells and terminally differentiated effector memory T cells re-expressing CD45RA (TEMRA). We also observed concomitant alterations to human leucocyte antigen D-related (HLA-DR), CD64 and CD14 expression in distinct myeloid subsets and a rapid activation of CD4+ T cells based on CD69 expression. The CD69+ CD4+ T cell phenotype inversely correlated with stroke severity and was associated with naive and central memory T (TCM) cells. Our findings highlight early changes in both the innate and adaptive immune compartments for further investigation as they could have implications the development of post-stroke infection and poorer patient outcomes.
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Affiliation(s)
- S. Krishnan
- Geoffrey Jefferson Brain Research CentreFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Lydia Becker Institute of Immunology and InflammationFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Division of Infection, Immunity and Respiratory MedicineSchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - C. O’Boyle
- Lydia Becker Institute of Immunology and InflammationFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - C. J. Smith
- Geoffrey Jefferson Brain Research CentreFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Lydia Becker Institute of Immunology and InflammationFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Division of Cardiovascular SciencesUniversity of ManchesterManchester Academic Health Science CentreSalford Royal NHS Foundation TrustSalfordUK
- Manchester Centre for Clinical NeurosciencesSalford Royal NHS Foundation TrustSalfordUK
| | - S. Hulme
- Division of Cardiovascular SciencesUniversity of ManchesterManchester Academic Health Science CentreSalford Royal NHS Foundation TrustSalfordUK
- Manchester Centre for Clinical NeurosciencesSalford Royal NHS Foundation TrustSalfordUK
| | - S. M. Allan
- Geoffrey Jefferson Brain Research CentreFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Lydia Becker Institute of Immunology and InflammationFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - J. R. Grainger
- Lydia Becker Institute of Immunology and InflammationFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Division of Infection, Immunity and Respiratory MedicineSchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - C. B. Lawrence
- Geoffrey Jefferson Brain Research CentreFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Lydia Becker Institute of Immunology and InflammationFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
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Liu YL, Wu ZQ, Qu JF, Qiu DH, Luo GP, Yin HP, Fang XW, Wang F, Chen YK. High neutrophil-to-lymphocyte ratio is a predictor of poor short-term outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis. Brain Behav 2020; 10:e01857. [PMID: 32981201 PMCID: PMC7749577 DOI: 10.1002/brb3.1857] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Very few studies have investigated the specific relationship between neutrophil-to-lymphocyte ratio (NLR) and the short-term outcomes of patients suffering from mild acute ischemic stroke (AIS) and receiving intravenous thrombolysis (IVT). This study aimed to investigate whether a high NLR is associated with a poor short-term outcome in patients with mild AIS after IVT. METHODS We retrospectively analyzed data that were prospectively acquired from patients with AIS treated with IVT. Mild AIS was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≤ 7 on admission. The NLR was based on a blood test performed prior to IVT and was classified as 'high' when exceeding the 75th percentile. Follow-ups were performed at discharge and 3 months after onset. A poor outcome was defined as a modified Rankin scale (mRS) ≥3. RESULTS A total of 192 patients were included in this study. The median NLR was 3.0 (interquartile range [IQR]: 2.0-3.9). Fifty-one patients (26.6%) had a high NLR (≥3.9) on admission. Forty-one patients (21.4%) had a poor outcome at discharge, while 34 patients (17.7%) had a poor outcome at 3 months. Patients with a poor outcome at discharge, and at 3 months after onset, were more likely to have a high NLR at discharge (42.9% vs. 21.9%; p = .005) and at 3 months (44.1% vs. 22.8%; p = .011), compared with those with a better outcome. After adjustment for NIHSS score on admission, ipsilateral severe intracranial large artery occlusion, and atrial fibrillation, logistic regression analyses revealed that a high NLR was a significant predictor of poor outcome at discharge and at 3 months after onset. CONCLUSIONS A high NLR on admission could be a useful marker for predicting poor short-term outcome in patients with mild AIS following IVT.
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Affiliation(s)
- Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Zhi-Qiang Wu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Dong-Hai Qiu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Gen-Pei Luo
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Han-Peng Yin
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
| | - Xue-Wen Fang
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Fang Wang
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China
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Świtońska M, Piekuś-Słomka N, Słomka A, Sokal P, Żekanowska E, Lattanzi S. Neutrophil-to-Lymphocyte Ratio and Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients Undergoing Revascularization. Brain Sci 2020; 10:brainsci10110771. [PMID: 33114150 PMCID: PMC7690817 DOI: 10.3390/brainsci10110771] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives: Symptomatic hemorrhagic transformation (sHT) is a life-threatening complication of acute ischemic stroke (AIS). The early identification of the patients at increased risk of sHT can have clinically relevant implications. The aim of this study was to explore the validity and accuracy of the neutrophil-to-lymphocyte ratio (NLR) in predicting sHT in patients with AIS undergoing revascularization. Methods: Consecutive patients hospitalized for AIS who underwent intravenous thrombolysis, mechanical thrombectomy or both were identified. The NLR values were estimated at admission. The study endpoint was the occurrence of sHT within 24 h from stroke treatment. Results: Fifty-one patients with AIS were included, with a median age of 67 (interquartile range, 55–78) years. sHT occurred in 10 (19.6%) patients. Patients who developed sHT had higher NLR at admission. NLR was an independent predictor of sHT and showed good discriminatory power (area under the curve 0.81). In a multivariable analysis, NLR and systolic blood pressure were independently associated with sHT. Conclusions: NLR at admission can accurately predict sHT in patients with AIS undergoing revascularization.
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Affiliation(s)
- Milena Świtońska
- Department of Neurosurgery and Neurology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, 85-168 Bydgoszcz, Poland;
- Correspondence: ; Tel.: +48-52-365-5565
| | - Natalia Piekuś-Słomka
- Department of Inorganic and Analytical Chemistry, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, 85-089 Bydgoszcz, Poland;
| | - Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, 85-094 Bydgoszcz, Poland; (A.S.); (E.Ż.)
| | - Paweł Sokal
- Department of Neurosurgery and Neurology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, 85-168 Bydgoszcz, Poland;
| | - Ewa Żekanowska
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, 85-094 Bydgoszcz, Poland; (A.S.); (E.Ż.)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, 60121 Ancona, Italy;
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21
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Wang L, Guo W, Wang C, Yang X, Hao Z, Wu S, Zhang S, Wu B, Liu M. Dynamic Change of Neutrophil to Lymphocyte Ratios and Infection in Patients with Acute Ischemic Stroke. Curr Neurovasc Res 2020; 17:294-303. [PMID: 32268864 DOI: 10.2174/1567202617666200408091131] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
Background:
Neutrophil to lymphocyte ratio (NLR) on admission was reported to be a
predictor of pneumonia after stroke. The aim of this study was to investigate the association between
the temporal change of NLR and post-stroke infection and whether infection modified the
effect of NLR on the outcome.
Methods:
We enrolled patients with acute ischemic stroke within 24 h after onset. The blood was
collected on admission, day 1, 3, 7 after admission to detect white blood cells (WBC), neutrophils,
and lymphocytes. Primary outcomes included pneumonia, urinary tract infection (UTI), other infection,
and the secondary outcome was 3-month death.
Results:
Of 798 stroke patients, 299 (37.66%) developed infection with 240 (30.23%) pneumonia,
78 (9.82%) UTI, and 9 (1.13%) other infection. The median time of infection occurrence was 48 h
(interquartile range 27-74 h) after onset. NLR reached to the peak at 36 h. For all outcomes, NLR
at 36 h after stroke had the highest predictive value than WBC, neutrophil, lymphocyte. NLR was
independently associated with the presence of any infection (odds ratio [OR] 1.11, 95% confidence
interval [CI] 1.05-1.17), pneumonia (OR 1.12, 95%CI 1.05-1.19), but not UTI (OR 0.95, 95%CI
0.89-1.01). Adding infection or the interaction term did not substantially change the OR of NLR
predicting 3-month death (OR 1.09, 95%CI 1.01, 1.17).
Conclusion:
Increased NLR around 36 h after stroke was a predictor of infection in patients with
acute ischemic stroke. The increased NLR value was associated with a higher risk of 3-month
death, which was independent of poststroke infection.
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Affiliation(s)
- Lu Wang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Wen Guo
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Changyi Wang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Xue Yang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Zilong Hao
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Simiao Wu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Shihong Zhang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Bo Wu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Ming Liu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
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Larmann J, Handke J, Scholz AS, Dehne S, Arens C, Gillmann HJ, Uhle F, Motsch J, Weigand MA, Janssen H. Preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with major adverse cardiovascular and cerebrovascular events in coronary heart disease patients undergoing non-cardiac surgery. BMC Cardiovasc Disord 2020; 20:230. [PMID: 32423376 PMCID: PMC7236311 DOI: 10.1186/s12872-020-01500-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preoperative risk prediction in patients at elevated cardiovascular risk shows limited accuracy. Platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) indicate systemic inflammation. Both have been investigated for outcome prediction in the field of oncology and cardiovascular medicine, as well as risk prediction of adverse cardiovascular events in non-surgical patients at increased cardiovascular risk. METHODS For this post-hoc analysis, we included all 38 coronary heart disease patients from the Leukocytes and Cardiovascular Perioperative Events cohort-1 study scheduled for elective non-cardiac surgery. We evaluated preoperative differential blood counts for association with major adverse cardiovascular and cerebrovascular events (MACCE) defined as the composite endpoint of death, myocardial ischemia, myocardial infarction, myocardial injury after non-cardiac surgery, or embolic or thrombotic stroke within 30 days after surgery. We used Youden's index to calculate cut-off values for PLR and NLR. Additive risk-predictive values were assessed using receiver operating characteristic curve and net reclassification (NRI) improvement analyses. RESULTS Patients with the composite endpoint MACCE had higher PLR and NLR (309 [206; 380] vs. 160 [132; 203], p = 0.001; 4.9 [3.5; 8.1] vs. 2.6 [2.2; 3.4]), p = 0.001). Calculated cut-offs for PLR > 204.4 and NLR > 3.1 were associated with increased risk of 30-day MACCE (OR 7, 95% CI [1.2; 44.7], p = 0.034; OR 36, 95% CI [1.8; 686.6], p = 0.001). Furthermore, NLR improved risk prediction in coronary heart disease patients undergoing non-cardiac surgery when combined with hs-cTnT or NT-proBNP (NRI total = 0.23, p = 0.008, NRI total = 0.26, p = 0.005). CONCLUSIONS Both PLR and NLR were associated with perioperative cardiovascular adverse events in coronary heart disease patients. NLR proved to be of additional value for preoperative risk stratification. Both PLR and NLR could be used as inexpensive and broadly available tools for perioperative risk assessment. TRIAL REGISTRATION NCT02874508, August 22, 2016.
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Affiliation(s)
- Jan Larmann
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Jessica Handke
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Anna S Scholz
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Sarah Dehne
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Christoph Arens
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hans-Jörg Gillmann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Florian Uhle
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Johann Motsch
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Henrike Janssen
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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