Elevated neutrophil‑to‑lymphocyte and platelet‑to‑lymphocyte ratios predict post‑stroke depression with acute ischemic stroke

Abstract

Post-stroke depression (PSD) is the most prevalent psychiatric complication of acute ischemic stroke. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are indicators of inflammation and are associated with stroke and depression. Therefore, the purpose of the present study was to examine the relationship between NLR/PLR and PSD. Retrospective analysis was carried out in 376 patients with first-ever acute ischemic stroke in the First Affiliated Yijishan Hospital of Wannan Medical College between March 2015 and September 2017. Patients were divided into PSD (n=104; 27.7%) and non-PSD (n=272; 72.3%) groups according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria at 6 months after stroke. Clinical data were collected retrospectively. NLR and PLR were acquired retrospectively from the routine blood tests performed at admission. A total of 120 healthy volunteers from the physical examination center in the First Affiliated Yijishan Hospital of Wannan Medical College were recruited as controls. Using logistic regression analysis, NLR (≥4.02) and PLR (≥203.74) were independently associated with PSD. NLR, odds ratio (OR) 3.926, 95% confidence intervals (CI, 2.365-7.947), P<0.001; PLR, OR 3.853, 95% CI (2.214-6.632), P=0.002. The ability of the combined index [area under the receiver operating characteristic curve, 0.701; 95% CI (0.622-0.780); P<0.001] to diagnose PSD was greater than that of either ratio alone. Higher NLRs and PLRs (≥4th quartile) were associated with PSD with a 5.79-fold (P<0.001) increase compared with lower levels of both. Higher NLRs and PLRs were found to be associated with depression 6 months after stroke, and the combined index was more meaningful than either alone in the early clinical detection of PSD.

Association Between Systemic Immune-Inflammation Index and Diabetic Depression

“…15 Inflammatory biomarkers could potentially be used to predict depression in diabetic patients. Abnormal increases in inflammatory blood cell parameters including neutrophil count, neutrophil-to-lymphocyte ratio, 16,17 monocyte-to-lymphocyte ratio, 18 and platelet-tolymphocyte ratio 19,20 serve as simple markers of inflammation and their ability to predict depression has been assessed. But these biomarkers involve only two types of immune-inflammatory cells and might not accurately reflect the inflammation status.…”

Universally Available Innate and Adaptive Immune Cell Counts in Acute Ischemic Stroke (AIS) in the Context of Shared Pathobiology with COVID-19; Scoping Review

“…The Neutrophil's use to lymphocyte ratio as a predictor for depression among stroke patients has been well documented in the literature (78)(79)(80). In a prospective study involving 299 ischemic stroke patients, increased NLR during admission was correlated to PSD after one month, with diagnosis based on the 17-Hamilton rating scale (81).…”

“…Using the Quick Inventory for Depression Symptomology (QIDS), Wolde et al showed the positive correlation between high NLR on acute stroke presentation and the occurrence of depression after 30 days (79). A retrospective study of more than 300 patients also demonstrated that in conjunction with platelet to lymphocyte ratio, high admission NLR is associated with depression at six months after stroke (82).On the other hand, a correlation of depression severity has also been demonstrated with increasing NLR among patients without stroke but with significant vascular risk factors (83).…”

Post Stroke Depression to be Expected

“…Microglial cells are thought to be the prime players of the CNS in its own immune and inflammatory responses while pro-apoptotic pathways are activated as a result of the inflammation [46]. While these processes are usually localized to the CNS, a systemic immune response is also manifested as evidenced by peripheral inflammatory biomarkers such as the neutrophil to lymphocyte ratio [47][48][49][50][51]. Using various depression scales such as HAM-D and Quick Inventory for Depression Symptomatology (QIDS), it has been demonstrated that a high NLR ratio on admission predicted PSD after one month [50,52].…”

“…Using various depression scales such as HAM-D and Quick Inventory for Depression Symptomatology (QIDS), it has been demonstrated that a high NLR ratio on admission predicted PSD after one month [50,52]. Furthermore, Hu et al reported in a retrospective study of more than 300 patients that in conjunction with platelet to lymphocyte ratio, admission NLR is associated with depression at six months after stroke [47] An important mechanism which leads to the occurrence of depression is low grade inflammation which may have an impact in dopaminergic systems [53]. A study by Tang et al illustrated that among patients with ischemic stroke, high sensitivity CRP (hsCRP) obtained during admission has been shown to correlate with depression at six months post stroke [54].…”