Diagnostic Value of Neutrophil-Lymphocyte Ratio to Differentiate Ischemic and Hemorrhagic Stroke

Abstract

IntroductionStroke is a neurologic emergency disease and the main cause of high mortality. Inflammatory process in stroke due to cell and tissue damage causes increase of leucocyte prominently neutrophil. Neutrophil Limphocyte Ratio is an easy-to-measure inflammatory marker. There is only few data of RNL in Indonesia.MethodsThis was a retrospective cross-sectional study using secondary data from Medical Record RSUP Wahidin Sudirohusodo, Makassar. Leucocyte, neutrophil and lymphocyte first data were taken from adult stroke diagnosed patients. Data statistically analyzed and diagnostic value of NLR was determined by ROC curve analysis.Results dan DiscussionTotal of 402 patients were enrolled, 214 (54.72%) with ischemic stroke and 182 (46.8) with hemorrhagic stroke. There was a significant RNL difference between ischemic stroke (median 7.23) and hemorrhage stroke (median 3.65) (p<0.001). Using cut off 5.18, ROC curve showed of AUC 0.730 which had weak perfomance to differentiate ischemic and hemorrhagic stroke with sensitivity 67.8% and specificity 68.6%.Conclusion and SuggestionNLR in hemorrhagic stroke is higher than ischemic stroke. We suggest further studies with larger and more evenly distributed samples and consideration of sampling time.

An Elevated Neutrophil-to-Lymphocyte Ratio Predicts In-Hospital Mortality in Stroke Patients: A Prospective Cohort Study

“…Inflammation plays a vital role in the evolution of stroke and its recovery. Pro-inflammatory cytokines, especially IL-8, help in recruiting neutrophils during the inflammatory response [ 5 ]. These neutrophils then release various pro-inflammatory cytokines like adhesion molecules (e.g., P-selectin), cytokines (e.g., IL-1, IL-6), chemokines (e.g., CCL2), proteases (e.g., matrix metalloproteinase-9) and free oxygen radicals, which damage neurons and lead to the release of damage-associated molecular patterns (DAMPs) from the injured brain tissue [ 8 , 9 ].…”

“…A reason for this is hypothesized to be the release of glucocorticoids by the hypothalamic-pituitary axis, which produces an anti-inflammatory response and decreases lymphocyte counts [ 8 ]. A decrease in lymphocyte count is also due to lymphocyte adhesion to endothelial cells during inflammation and lymphocyte migration to inflamed tissues [ 5 ]. Acute brain injury also inactivates the lymphocytes, which markedly impairs the immune system [ 11 ].…”

“…Inflammation occurs when stagnant blood flow due to ischemic or hemorrhagic lesions results in the release and accumulation of pro-inflammatory mediators, which lead to the migration of neutrophils to the area of stroke. A decrease in lymphocyte count occurs due to lymphocyte adhesion to endothelial cells during inflammation and also due to lymphocyte migration to inflamed tissues [ 5 ].…”