Eosinophil-to-monocyte ratio is a potential biomarker in the prediction of functional outcome among patients with acute ischemic stroke

Abstract

Background and PurposeIt has been showed that eosinophils are decreased and monocytes are elevated in patients with ischemic stroke, but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among patients with acute ischemic stroke remains unclear. The aim of this study is to determine the relationship between EMR on admission and three-month poor functional outcome in patients with acute ischemic stroke.MethodsA total of 521 consecutive patients admitted to our hospital within 24 hours after onset of acute ischemic stroke were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission.ResultsAs EMR decreased, the risk of poor outcome increased (P<0.001). Logistic regression analysis revealed that EMR was independently associated with poor outcome after adjusting potential confounders (odds ratio, 0.10; 95% CI, 0.03–0.36; P=0.0004), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.24; 95% CI, 0.10–0.53; Ptrend<0.0001). A non-linear relationship was detected between EMR and poor outcome, whose point was 0.28. Subgroup analyses further confirmed these associations. The area under the curve of EMR for the prediction of poor outcome in receiver operating characteristic analysis was 0.653 (95% CI, 0.603–0.703; P=0.003). Furthermore, the addition of EMR to conventional risk factors improved the predictive power for poor outcome (net reclassification improvement: 3.54%, P=0.230; integrated discrimination improvement: 2.11%, P=0.001).ConclusionEMR on admission was independently correlated with poor outcome in patients with acute ischemic stroke, suggesting that EMR may be a potential prognostic biomarker for ischemic stroke.