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Tsalta-Mladenov ME, Andonova SP. Peripheral blood cell count ratios as a predictor of poor functional outcome in patients with acute ischemic stroke. Neurol Res 2024; 46:213-219. [PMID: 37846878 DOI: 10.1080/01616412.2023.2270336] [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: 06/22/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Acute ischemic stroke (AIS) is a leading cause of death and long-term disability worldwide. Thromboinflammation plays an important role in the pathophysiology of stroke. The peripheral blood cell count ratios (PBCCR): neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), are global inflammatory indicators with prognostic value for the clinical outcome after stroke. We aimed to determine the relationship between NLR, PLR, or LMR and the functional outcome three months post-stroke. METHODS A prospective, hospital-based study, including 141 participants with AIS, was conducted at a referral stroke center in North-Eastern Bulgaria. The PBCCRs were obtained during the first 24 hours after stroke onset. Stroke severity was measured using the NIHSS scale, and functional outcome was assessed with the modified Rankin Scale (mRS) at discharge and 3 months post-stroke. RESULTS We found significantly lower total lymphocyte counts, and higher NLR, PLR, and C-reactive protein in the poor-outcome group (mRS>3) three months post-stroke. A positive correlation was found between the NIHSS score and mRS score on discharge, NLR, and PLR with the worse outcome on the third month. The receiver operating characteristic (ROC) curves showed the predictability of NLR (AUC, 0.626, 95%CI: 0.524-0.724, p = 0.018), and for PLR- (AUC, 0.613, 95%CI: 0.510-0.716, p = 0.031). The optimal cutoff value for NLR was 2.68 (sensitivity 77.8% and specificity 60.4%), and for PLR - 122.6 (sensitivity 77.8% and specificity 61.5%). CONCLUSION Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are simple, widely available, and cost-effective biomarkers with high prognostic value for the clinical outcome three months post-stroke.
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Affiliation(s)
- Mihael Emilov Tsalta-Mladenov
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
- Second Clinic of Neurology with ICU and Stroke unit, University Hospital "Sveta Marina", Varna, Bulgaria
| | - Silva Peteva Andonova
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
- Second Clinic of Neurology with ICU and Stroke unit, University Hospital "Sveta Marina", Varna, Bulgaria
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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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Zhang YX, Shen ZY, Jia YC, Guo X, Guo XS, Xing Y, Tian SJ. The Association of the Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio and Systemic Inflammation Response Index with Short-Term Functional Outcome in Patients with Acute Ischemic Stroke. J Inflamm Res 2023; 16:3619-3630. [PMID: 37641703 PMCID: PMC10460585 DOI: 10.2147/jir.s418106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
Background and Purpose The aim of this study was to explore the relationship between functional prognosis and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic inflammatory response index (SIRI) in patients with acute ischemic stroke (AIS) at discharge. Methods A total of 861 patients with AIS were enrolled between January 2019 and December 2021. Blood cell counts were collected on admission. Logistic regression analysis was performed to assess the relationship between NLR, PLR, LMR, SIRI and adverse functional outcomes (modified Rankin scale score of 3-6) at discharge. We also used receiver operating characteristic (ROC) curves to estimate the overall ability of NLR, PLR, LMR and SIRI to judge short-term functional outcomes. Associations between NLR, PLR, LMR, and SIRI with length of hospital stay were analyzed by Spearman correlation test. Results A total of 194 patients (22.5%) had poor functional outcomes at discharge. Multivariate logistic regression analysis showed that NLR (odds ratio [OR], 1.060; 95% confidence interval [CI] 1.004-1.120, P=0.037), PLR (OR, 1.003; 95% CI 1.000-1.005, P=0.018), LMR (OR, 0.872; 95% CI 0.774-0.981, P=0.023) and SIRI (OR, 1.099; 95% CI 1.020-1.184, P=0.013) were independent factors for poor functional outcome. The odds ratios of the highest versus lowest quartiles of NLR, PLR and SIRI were 2.495 (95% CI 1.394-4.466), 1.959 (95% CI 1.138-3.373) and 1.866 (95% CI 1.106-3.146), respectively. The odds ratio of the lowest versus highest quartile of LMR was 2.300 (95% CI 1.331-3.975). The areas under the curve (AUCs) of the NLR, PLR, LMR, and SIRI to discriminate poor functional prognosis were 0.644, 0.587, 0.628, and 0.651, respectively. NLR, LMR, and SIRI were related with the length of hospital stay (P<0.05). Conclusion NLR, PLR, LMR, and SIRI were associated with functional outcome at discharge in AIS patients. NLR, LMR and SIRI were related to hospitalization days in patients with AIS.
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Affiliation(s)
- Ya Xin Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Zhi Yuan Shen
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Yi Cun Jia
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Xin Guo
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Xiao Su Guo
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Yuan Xing
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Shu Juan Tian
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
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Hu X, Liang J, Hao W, Zhou J, Gao Y, Gong X, Liu Y. Prognostic value of inflammatory markers for in-hospital mortality in intensive care patients with acute ischemic stroke: a retrospective observational study based on MIMIC-IV. Front Neurol 2023; 14:1174711. [PMID: 37360337 PMCID: PMC10285211 DOI: 10.3389/fneur.2023.1174711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Background Acute ischemic stroke (AIS) is a primary cause of death and disability worldwide. Four markers that can be readily determined from peripheral blood, namely, the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and total bilirubin, were measured in this study. We examined the relationship between the SII and in-hospital mortality after AIS and evaluated which of the above four indicators was most accurate for predicting in-hospital mortality after AIS. Methods We selected patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database who were aged >18 years and who were diagnosed with AIS on admission. We collected the patients' baseline characteristics, including various clinical and laboratory data. To investigate the relationship between the SII and in-hospital mortality in patients with AIS, we employed the generalized additive model (GAM). Differences in in-hospital mortality between the groups were summarized by the Kaplan-Meier survival analysis and the log-rank test. The receiver operating characteristic (ROC) curve analysis was used to assess the accuracy of the four indicators (SII, NLR, PLR, and total bilirubin) for predicting in-hospital mortality in patients with AIS. Results The study included 463 patients, and the in-hospital mortality rate was 12.31%. The GAM analysis showed a positive correlation between the SII and in-hospital mortality in patients with AIS, but the correlation was not linear. Unadjusted Cox regression identified a link between a high SII and an increased probability of in-hospital mortality. We also found that patients with an SII of >1,232 (Q2 group) had a considerably higher chance of in-hospital mortality than those with a low SII (Q1 group). The Kaplan-Meier analysis demonstrated that patients with an elevated SII had a significantly lower chance of surviving their hospital stay than those with a low SII. According to the results of the ROC curve analysis, the in-hospital mortality of patients with AIS predicted by the SII had an area under the ROC curve of 0.65, which revealed that the SII had a better discriminative ability than the NLR, PLR, and total bilirubin. Conclusion The in-hospital mortality of patients with AIS and the SII were positively correlated, but not linearly. A high SII was associated with a worse prognosis in patients with AIS. The SII had a modest level of discrimination for forecasting in-hospital mortality. The SII was slightly better than the NLR and significantly better than the PLR and total bilirubin for predicting in-hospital mortality in patients with AIS.
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Affiliation(s)
- Xuyang Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Jiaru Liang
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Wenjian Hao
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Jiaqi Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuling Gao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoyang Gong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yong Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
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