Clinical Summary

Neutrophil-to-lymphocyte ratio could be a marker for early worsening in stroke

Sarfaroj Khan

Takeaway

In patients with ischaemic stroke because of large-artery atherosclerosis (LAA), serum neutrophil-to-lymphocyte ratio (NLR) levels at admission were independently associated with early neurological deterioration (END) events, especially in those with in-situ thrombosis.
NLR levels were also closely related to the underlying vascular lesion burden.

Why this matters

Findings suggest that NLR could be an independent predictor for END, even though it is a surrogate marker for severe stroke.

Study design

Retrospective study evaluated the association between NLR and END in patients with ischaemic stroke because of LAA (n=349; median age 69 years).
END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 hours of admission.
Funding: National Research Foundation of Korea.

Key results

63 (18.1%) patients reported END events.
Multivariable analysis revealed that NLR was a positive predictor for END (aOR, 1.08; 95% CI, 1.00-1.16; P=.043).
END was significantly associated with:
- time to admission (aOR, 0.98; 95% CI, 0.96-0.99; P=.009),
- artery-to-artery embolisation mechanism (aOR, 0.43; 95% CI, 0.21-0.88; P=.021) and
- in-situ thrombosis mechanism (aOR, 2.26; 95% CI, 1.04-4.91; P=.041).
Serum NLR levels were positively correlated with the degree of stenotic lesions (P for trend=.006) and the number of vessel stenosis (P for trend=.038) in a dose-response manner.
Patients with in-situ thrombosis had significantly higher NLR in the END vs non-END group (P=.005).

Limitations

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