Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis

Song, Shu; Zhao, Xiaoxi; Rajah, Gary; Hua, Chang; Kang, Rui-jun; Han, Yipeng; Ding, Yuchuan; Meng, Ran

doi:10.3389/fneur.2019.01032

Cited by 103 publications

(116 citation statements)

References 78 publications

(67 reference statements)

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“…As previously discussed, the changes in peripheral leukocyte counts may be epiphenomenal to brain damage. However, previous studies have revealed that higher leukocyte counts in healthy patients are also associated with the increased risk of ischemic stroke events [2,32]. Further investigation may clarify how peripheral leukocyte counts are related to the risk of suffering an LVO is AIS, or how it may affect the composition of the thrombi.…”

Section: Discussionmentioning

confidence: 92%

“…Ischemic brain damage elicits systematic inflammatory response and cause a time-dependent activation of peripheral immune cells [1]. Leukocyte counts and ratios (such as neutrophilto-lymphocyte ratio) in peripheral blood proved to have good prognostic value to predict outcomes and post-stroke complications [2,3]. Higher leukocyte counts, especially neutrophil elevation is also associated with increasing severity and larger infarct volumes in AIS [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Relationship between leukocyte counts and large vessel occlusion in acute ischemic stroke

et al. 2020

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Background Neuroinflammation plays an important role in the pathogenesis of acute ischemic stroke (AIS) and peripheral leukocyte counts have proved to be independent predictors of stroke severity and outcomes. Clinical significance of large vessel occlusion (LVO) in AIS is increasing, as these patients are potential candidates for endovascular thrombectomy and likely to have worse outcomes if not treated urgently. The aim of our study was to assess the relationship between on admission leukocyte counts and the presence of LVO in the early phase of AIS. Methods We have conducted a cross-sectional, observational study based on a registry of consecutive AIS patients admitted up to 4.5 h after stroke onset. Blood samples were taken at admission and leukocyte counts were measured immediately. The presence of LVO was verified based on the computed tomography angiography scan on admission. Results Total white blood cell (WBC) and neutrophil counts were significantly higher in patients with LVO than those without LVO (P < 0.001 respectively). After adjustment for potential confounders total WBC counts (adjusted OR: 1.405 per 1 × 109/L increase, 95% CI: 1.209 to 1.632) and neutrophil counts (adjusted OR: 1.344 per 1 × 109/L increase, 95% CI: 1.155 to 1.564) were found to have the strongest associations with the presence of LVO. Total WBC and neutrophil counts had moderate ability to discriminate an LVO in AIS (AUC: 0.667 and 0.655 respectively). No differences were recorded in leukocyte counts according to the size of the occluded vessel and the status of collateral circulation in the anterior vascular territory. However, total WBC and neutrophil counts tended to be higher in patients with LVO in the posterior circulation (p = 0.005 and 0.010 respectively). Conclusion Higher admission total WBC and neutrophil counts are strongly associated with the presence of LVO and has moderate ability to discriminate an LVO in AIS. Detailed evaluation of stroke-evoked inflammatory mechanisms and changes according to the presence of LVO demands further investigation.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Relationship between leukocyte counts and large vessel occlusion in acute ischemic stroke

et al. 2020

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show abstract

“…As previously discussed, the changes in peripheral leukocyte counts may be epiphenomenal to brain damage. However, previous studies have revealed that higher leukocyte counts in healthy patients are also associated with the increased risk of ischemic stroke events [2,26]. Further investigation may clarify how peripheral leukocyte counts are related to the risk of suffering an LVO is AIS, or how it may affect the composition of the thrombi.…”

Section: Discussionmentioning

confidence: 92%

“…Ischemic brain damage elicits systematic in ammatory response and cause a time-dependent activation of peripheral immune cells [1]. Leukocyte counts and ratios (such as neutrophil-to-lymphocyte ratio) in peripheral blood proved to have good prognostic value to predict outcomes and post-stroke complications [2,3]. Higher leukocyte counts, especially neutrophil elevation is also associated with increasing severity and larger infarct volumes in AIS [4,5].…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Leukocyte Counts and Large Vessel Occlusion in Acute Ischemic Stroke

Tarkanyi

Karadi

Szabó

et al. 2020

Preprint

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Background: Neuroinflammation plays an important role in the pathogenesis of acute ischemic stroke (AIS) and peripheral leukocyte counts have proved to be independent predictors of stroke severity and outcomes. Clinical significance of large vessel occlusion (LVO) in AIS is increasing, as these patients are potential candidates for endovascular thrombectomy and likely to have worse outcomes if not treated urgently. The aim of our study was to assess the relationship between on admission leukocyte counts and the presence of LVO in the early phase of AIS.Methods: We have conducted a cross-sectional, observational study based on a registry of consecutive AIS patients admitted up to 4.5 hours after stroke onset. Blood samples were taken at admission and leukocyte counts were measured immediately. The presence of LVO was verified based on the computed tomography angiography scan on admission.Results: Total white blood cell (WBC) and neutrophil counts were significantly higher in patients with LVO than those without LVO (P<0.001 respectively). After adjustment for potential confounders total WBC counts (adjusted OR: 1.405 per 1x109/L increase, 95% CI: 1.209 to 1.632) and neutrophil counts (adjusted OR: 1.344 per 1x109/L increase, 95% CI: 1.155 to 1.564) were found to have the strongest associations with the presence of LVO. Total WBC and neutrophil counts had moderate ability to discriminate an LVO in AIS (AUC: 0.667 and 0.655 respectively). No differences were recorded in leukocyte counts according to the size of the occluded vessel and the status of collateral circulation in the anterior vascular territory. However, total WBC and neutrophil counts tended to be higher in patients with LVO in the posterior circulation (p= 0.005 and 0.010 respectively).Conclusion: Higher admission total WBC and neutrophil counts are strongly associated with the presence of LVO and has moderate ability to discriminate an LVO in AIS. Detailed evaluation of stroke-evoked inflammatory mechanisms and changes according to the presence of LVO demands further investigation.

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“…The neutrophil to lymphocyte ratio (NLR), as a simple parameter of innate (neutrophil), and adaptive (lymphocyte) immune response, is easy to obtain from peripheral blood (12). Recent studies show NLR can predict the prognosis and mortality of patients with aortic dissection or cerebral infarction (5, 13,14).…”

Section: Introductionmentioning

confidence: 99%

Neutrophil to Lymphocyte Ratio Predicts Outcome of Stroke by Cervicocranial Arterial Dissection

Sun

Chen

et al. 2020

Front. Med.

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Background and Purpose: Neutrophil to lymphocyte ratio (NLR) is positively associated with poor prognosis in patients with cerebral infarction. The goal of this prospective study is to explore the predictive value of NLR in patients with acute ischemic stroke (AIS) caused by cervicocranial arterial dissection (CCAD).Methods: Ninety-nine patients with AIS caused by CCAD met criteria for inclusion and exclusion were selected for this study. We collected baseline data on the admission including NLR. The primary poor outcome was major disability (modified Rankin Scale score ≥ 3) or death at 3 months after AIS.Results: A total of 20 (20.2%) patients had a poor outcome at 3 months after AIS. According to the 3-month outcome, the patients were divided into two groups and univariate and multivariable analyses were conducted. Among the risk factors, elevated NLR levels were independently associated with 3-month poor outcomes. Further, we made the ROC curve to evaluate the predictive value of NLR level on prognosis. The area under the curve was 0.79 and a cut-off value of NLR was 2.97 for differentiating the poor outcome. We divided patients into groups according to the cut-off value. Patients with high NLR have a higher risk of poor outcome than those with low NLR (P < 0.05).Conclusion: As an inflammatory marker, elevated NLR levels were associated with 3-month poor outcome in AIS caused by CCAD.

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Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis

Cited by 103 publications

References 78 publications

Relationship between leukocyte counts and large vessel occlusion in acute ischemic stroke

Relationship between leukocyte counts and large vessel occlusion in acute ischemic stroke

Relationship Between Leukocyte Counts and Large Vessel Occlusion in Acute Ischemic Stroke

Neutrophil to Lymphocyte Ratio Predicts Outcome of Stroke by Cervicocranial Arterial Dissection

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