Original Article
Is Neutrophil/Lymphocyte Ratio Predict to Short-term Mortality in Acute Cerebral Infarct Independently from Infarct Volume?

https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.04.007Get rights and content

Background

Neutrophil/lymphocyte ratio (NLR) is related with increased mortality in both myocardial infarction and acute ischemic stroke. It remains unclear whether NLR is a simple marker of ischemic infarct volume or an independent marker of stroke mortality. The aim of this study is to investigate the relationship of NLR with infarct volume and short-term mortality in acute ischemic stroke (AIS).

Methods

This retrospective study included 151 patients with first AIS that occurred within 24 hours of symptom onset. Patients were screened from the hospital's electronic record system by using International Classification of Diseases code (G 46.8). NLR was calculated as the ratio of neutrophils to lymphocytes. Short-term mortality was defined as 30-day mortality.

Results

A total 20 of 151 patients died during follow-up. Both NLR and infarct volume of nonsurvived group were significantly higher than survived group (P < .05). Infarct volume, NLR, and National Institutes of Health Stroke Scale (NIHSS) were independent predictors of the mortality in Cox regression analysis. The optimal cutoff value for NLR as a predictor for short-term mortality was determined as 4.81. NLR displayed a moderate correlation with both NIHSS and Glasgow Coma Scale (P < .01). NLR values were significantly higher in the highest infarct volume tertile than both in the lowest volume tertile and midtertile of infarct volume (P = .001).

Conclusions

NLR at the time of hospital admission maybe a predictor of short-term mortality independent from infarct volume in AIS patients. NLR should be investigated in future prospective trials investigating AIS.

Section snippets

Study Population

This study is a hospital-based retrospective investigation. A total of 655 patients with AIS more than 18 years of age who were admitted to Meram Medical School Hospital were screened between October 2007 and March 2013, and patients with a diagnosis of AIS in the first day were included in the study. The study protocol was approved by the local ethics committee.

Exclusion criteria for the patients were the following: (1) those who were admitted to the hospital 24 hours after AIS; (2) those with

Results

The mean age of 151 patients who were diagnosed with supratentorial AIS was 69.37 ± 13.96 years. The mortality rate was 13.2% (n = 20) by 30-day follow-up. Demographic and laboratory findings of survived and nonsurvived patients are reported in Table 1. Both NLR on admission to the hospital and infarct volume of nonsurvived group were significantly higher than survived group (P < .05). Also there were significant differences in terms of GCS, NIHSS, age, serum glucose, and so forth (Table 1).

The

Discussion

In recent literature, it is reported that the high NLR ratios in both acute coronary syndromes and AIS might be related with the vascular inflammation reaction8, 9; also the formed acute inflammation can affect the size of the infarct, which can be followed up with peripheral inflammatory parameters of acute inflammation.3, 7, 10 In our study, positive correlations between infarct volume with NLR and increased NLR ratios in the high infarct volume have been detected. Regression analyses have

Conclusion

NLR on admission to the hospital was a predictor of short-term mortality independent from infarct volume in patients with first AIS. Changing blood cell composition during acute ischemic stroke maybe more important than current knowledge. Thanks to the routine usage and inexpensive nature of hemogram analysis, NLR maybe a new research area for prospective trials in patients with AIS.

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