Elevated neutrophil to lymphocyte ratio and ischemic stroke risk in generally healthy adults

Abstract

Elevated neutrophil to lymphocyte ratio (NLR) has been reported as a marker for chronic inflammation, associated with poor prognosis in ischemic stroke patients, but there has been no study that investigated its association with ischemic stroke risk. This study was conducted to investigate elevated NLR as an independent risk factor for ischemic stroke incidence. Our retrospective cohort study included 24,708 generally healthy subjects aged 30–75 who received self-referred health screening at Seoul National University Hospital. Data on ischemic stroke incidence was retrieved from national medical claims registry. Median follow-up time was 5.9 years (interquartile range 4.2 years). Adjusted for major cardiovascular risk factors, compared to subjects with NLR<1.5, subjects with 2.5≤NLR<3.0, 3.0≤NLR<3.5, and NLR≥3.5 had elevated risk for ischemic stroke incidence with aHR (95% CI) of 1.76 (1.09–2.84), 2.21 (1.21–4.04), and 2.96 (1.57–5.58), respectively. NLR showed significant improvement in discrimination for ischemic stroke incidence compared to traditional cardiovascular risk factors (C-index 0.748 vs. 0.739, P = 0.025). There was significant net improvement in reclassification in Framingham risk for ischemic stroke incidence after addition of NLR, with IDI 0.0035 (P<0.0001), and NRI 6.02% (P = 0.0015). This reclassification for ischemic stroke incidence by NLR was markedly pronounced among subjects with atrial fibrillation with CHA2DS2-VASc<2 (NRI 42.41%, P = 0.056). Our study suggests elevated NLR to be an independent risk factor for ischemic stroke incidence in generally healthy adults. Future studies are needed to validate our results and further assess how subjects with elevated NLR should be managed within current guidelines.

Basal Hormones and Biochemical Markers as Predictors of Overtraining Syndrome in Male Athletes: The EROS-BASAL Study

“…The neutrophil : lymphocyte ratio is increasingly recognized for its prognostic value in cardiovascular disease, infection, inflammatory diseases, and several types of cancer 21,22 ; an increased neutrophil : lymphocyte ratio was shown to predict a poorer prognosis, 21 although a normal range is yet to be determined. However, the unprecedented finding of an increased neutrophil : lymphocyte ratio in the absence of any abnormalities may suggest an additional adaptive process that occurs in response to training.…”

miRNA Expression Profile of Saliva in Subjects of Yang Deficiency Constitution and Yin Deficiency Constitution

“…The medical model characterized by prediction, prevention, personalization and participation has gained greater prominence [1]. Some research has explored the individual differences between healthy population and associated disease risks [2,3]. However, it is not clear whether the normal healthy population, within a specific ethnic identity, can be classified into distinctive groups, where each group exhibits its own biological features and disease risks.…”

Neutrophil to Lymphocyte Ratio Predicts Short-Term Functional Outcome in Acute Ischemic Stroke

“…Tokgoz et al reported that the NLR at the time of hospital admission might be a predictor of short-term mortality independent of infarct volume in patients with AIS [42]. Furthermore, the NLR has been reported to be an independent risk factor for the incidence of AIS in generally healthy populations [2]. In our study, the NLR and the total WBC count were significantly higher in the poor outcome group than in the good outcome group, similar to results reported in other studies [23,24,[32][33][34].…”

“…It is well established that inflammation plays an important role in various atherosclerotic disorders [2,3]. Elevated blood inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) have been shown to be independent risk factors for cardiovascular disease and ischemic stroke [2,3].…”

“…Elevated blood inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) have been shown to be independent risk factors for cardiovascular disease and ischemic stroke [2,3]. Recently, there have been reports of leukocytes having a similar role in ischemic events [4,5].…”