High Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Pneumonia

Nam, Ki Woong; Kim, Tae Jung; Lee, Ji Sung; Kwon, Hyung‐Min; Lee, Yong Seok; Ko, Sang‐Bae; Yoon, Byung‐Woo

doi:10.1161/strokeaha.118.021228

Cited by 162 publications

(150 citation statements)

References 35 publications

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“…In this study, 11.8% of the patients were diagnosed with pneumonia after acute stroke during hospitalization, which is consistent with previous findings. 3,[24][25][26] We found that age and the severity of stoke (NIHSS score) affected the risk of SAP, and these were identified as risk factors for SAP in other population-based studies. 27,28 Moreover, in our study, 24.5% of the patients with SAP developed dysphagia, which was significantly increased compared to those without SAP.…”

Section: Discussionmentioning

confidence: 69%

<p>Reduced Vitamin D Levels are Associated with Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke</p>

Huang

Cheng

et al. 2019

CIA

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Background and aim: Stroke-associated pneumonia (SAP) is a common complication in patients with acute ischemic stroke (AIS). This study explored the potential relationship between serum vitamin D levels and SAP. Methods: This study recruited 863 consecutive AIS patients. In-hospital SAP was defined as a complication that occurred after stroke, during hospitalization, that was confirmed radiographically. Serum vitamin D levels were measured within 24 hrs of admission and the patients were divided into vitamin D sufficient (>50 nmol/L), insufficient (25-50 nmol/L), and deficient (<25 nmol/L) groups. Results: In this study, 102 (11.8%) patients were diagnosed with SAP. Compared to the patients without SAP, patients with SAP had significantly lower vitamin D levels (P = 0.023). The incidence of SAP was significantly higher in patients with vitamin D deficiency than in those with vitamin D insufficiency or sufficiency (21.2% vs 16.2% & 9.5%, P = 0.006). After adjusting for confounders, vitamin D deficiency and insufficiency were independently associated with SAP (OR = 3.034, 95% CI = 1.207-7.625, P = 0.018; OR = 1.921, 95% CI = 1.204-3.066, P = 0.006, respectively). In multiple-adjusted spline regression, vitamin D levels showed a linear association with the risk of SAP (P < 0.001 for linearity). Conclusion: Reduced vitamin D is a potential risk factor of in-hospital SAP, which can help clinicians identify high-risk SAP patients.

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Section: Discussionmentioning

confidence: 69%

<p>Reduced Vitamin D Levels are Associated with Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke</p>

Huang

Cheng

et al. 2019

CIA

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“…Second, after CCM hemorrhage, immunologic changes happen as the early systemic inflammatory response, which is altered through the sympathetic pathway and the hypothalamus-pituitary-adrenal axis [20][21][22] . As a result, neutrophil demargination occurs 17,23 . Morever, for CCM patients presenting with hemorrhage, steroids may be used with edema and therefore increase the WBC.…”

Section: Discussionmentioning

confidence: 99%

“…The patient could also have confirmed postoperative pneumonia, which means the symptom met all CDC diagnosis criteria, including at least one chest X-ray confirmed diagnostic change. In the current study, both possible and confirmed pneumonia as determined by the CDC criteria were considered as pneumonia 17 .…”

Section: Clinical Variables and Detection Of Postoperative Infection-mentioning

confidence: 99%

Predictive factors of postoperative infection-related complications in adult patients with cerebral cavernous malformations

Ding

Lian

et al. 2020

Sci Rep

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Materials and Methods Study population. Information of CCM patients admitted between January 2010 and December 2017 to the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University was retrospectively reviewed. A total of 167 patients were included, the average age of patients was 39.69 ± 15.27 years, with 43.1% (72/167) being female. The inclusion criteria were: (1) Age >18 years old; (2) diagnosed with CCM based on preoperative imaging, treated with surgery and confirmed with CCM based on postoperative pathological result. Exclusion criteria were: (1) Patient with incomplete disease information, such as missing any of the following: assessment of disease severity (including GCS, KPS and mRS) and WBC differential count (including the WBC count, neutrophil (NEU) count and lymphocyte (LYM) count) at admission, imaging and pathological information, and information on postoperative complications; (2) the patient had any type of surgery or acute or chronic infection within the past month; (3) prior onset of other neurological diseases such as intracranial tumors, stroke or severe head trauma; (4) patient had previous CCM surgery; (5) previous use of immunosuppressants; (6) other systemic diseases, such as autoimmune disease, uremia, cirrhosis, cancer, and chronic lung and heart diseases. The study conformed to the ethical guidelines of the Declaration of Helsinki. The local Ethics Committee of the First Affiliated Hospital of Fujian Medical University (Fujian, China) approved this study and waived the requirement for informed consent because of its retrospective design.

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“…Neutrophil-to-lymphocyte ratio (NLR) is an easily acquired, non-invasive, and inexpensive marker, which can be used routinely to indicate systematic in ammatory status in clinical work that has been studied as a predictor of bacterial infection, showing a superior predictive value than those of conventional in ammatory markers. In addition, the NLR has displayed good predictive power for pneumonia (8), as well as dose-response information relating to the burden of community-acquired pneumonia (8,9). NLR has been demonstrated to predict the prognosis in cerebral infarction and cerebral hemorrhage (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Increased neutrophil-to-lymphocyte ratio after thrombolysis better predicts 3-month stroke outcome

Hou¹,

Wang²,

Ye³

et al. 2020

Preprint

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Background-Thrombolysis has become an effective therapy for acute cerebral infarction (AIS) within 4.5 hours. Thrombolysis improves prognosis by increasing perfusion of the ischemic penumbra. Inflammation as one of the mechanisms of cerebral infarction, the role of thrombolysis is the topic of our exploration. Methods-From August 1, 2017 and September 1, 2019, 493 consecutive patients with AIS were prospectively enrolled in this cohort. 170 patients received thrombolytic therapy and 323 patients did not have thrombolysis. Clinical evaluation, laboratory data before and after thrombolysis and 3-month modified Rankin scale (mRS) scores were compared. Neutrophil-to-lymphocyte ratio (NLR), which represents inflammatory response, was divided into quartiles for comparison. Multivariate regression analysis was used to determine independent factors of 3-month prognosis. The receiver operating characteristic curve was used to evaluate the predictability of NLR for good prognosis that was defined as 3-month mRS scores < 3. Results-The NLR after thrombolysis was higher than that before thrombolysis (p < 0.001) and in non-thrombolytic patients (p < 0.001). NLR after thrombolysis is an independent predictor of 3-month functional outcome (odds ratio (OR) = 1.20, 95% confidence interval (CI), 1.01–1.42, p = 0.03). Also, a cutoff value of 4.51 for NLR was detected in predicting post-thrombolysis 3-month functional outcome with a sensitivity of 65.7% and a specificity of 73.1% (area under curve [AUC], 0.85; 95% CI, 0.77–0.92). We also found a significant difference (62% vs 88%, p < 0.001) in the proportion of good 3 months prognosis between the higher and lower group. Conclusions-This study showed that NLR increase after thrombolysis better predict post-thrombolytic unfavorable functional outcome in AIS patients. Clinical Trial Registration-URL: http://www.chictr.org.cn/index.aspx, Unique identifier: ChiCTR1800018315. URL: http://www.chictr.org.cn/index.aspx, Unique identifier: ChiCTR1800019615.

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High Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Pneumonia

Cited by 162 publications

References 35 publications

<p>Reduced Vitamin D Levels are Associated with Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke</p>

<p>Reduced Vitamin D Levels are Associated with Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke</p>

Predictive factors of postoperative infection-related complications in adult patients with cerebral cavernous malformations

Increased neutrophil-to-lymphocyte ratio after thrombolysis better predicts 3-month stroke outcome

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