Monocyte‐to‐lymphocyte ratio as a predictor of stroke‐associated pneumonia: A retrospective study‐based investigation

Cao, Feng; Wan, Yan‐Jun; Lei, Chunyan; Zhong, Lianmei; Lei, Hongtao; Hai-mei, Sun; Zhong, Xing; Xiao, YaDan

doi:10.1002/brb3.2141

Cited by 24 publications

(18 citation statements)

References 33 publications

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“… 13 In addition, the monocyte to lymphocyte ratio, a reverse ratio of LMR, was indicated to have a prognostic ability for stroke-associated pneumonia (SAP). 24 However, limited research investigated the predictive value of LMR for ICH prognosis. A small-sample and retrospective study showed LMR as a predictor for ND and 90-day mortality.…”

Section: Discussionmentioning

confidence: 99%

“…We also found an association between higher LMR values and a decreased risk of infections during hospitalization, which is in line with previous studies. 24 , 33 These findings provide a surrogate biomarker of the immune response induced by local cerebral hematoma and systemic inflammation, reflecting the likelihood of secondary brain injury and vulnerability to post-stroke infections. Accordingly, the early decrease of LMR values is driven by lymphocyte reduction and/or monocyte rise, which can enhance the reliable prediction of the risks of complicated infections, short-term mortality, and adverse functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Slightly Elevated Lymphocyte to Monocyte Ratio Predicting Favorable Outcomes in Patients with Spontaneous Intracerebral Hemorrhage

Wang¹,

Wang²,

Zhang³

et al. 2022

JIR

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Objective This study was designed to determine the association between admission lymphocyte to monocyte ratio (LMR) values and clinical outcomes in patients with spontaneous intracerebral hemorrhage (ICH). Methods We used a prospective and registry-based database, and ICH patients were consecutively recruited in Beijing Tiantan Hospital between January 2014 and September 2016. All participants were stratified by quartiles of the LMR. Univariable and multivariable logistic regression analyses were plotted to evaluate the association between LMR levels and functional outcomes. Kaplan–Meier survival curves and Cox regression analysis were also performed to examine the relevance between different LMR quartiles and case fatality at follow-up. Results Six hundred and forty patients with spontaneous ICH were finally included in this study. Compared with the patients with LMR values in quartile 1 (Q1), slightly elevated LMR values showed a negative correlation with risks of poor short-term outcomes (adjusted ORs in Q2 were 0.572 [95% CI: 0.338–0.968] at 1 month, 0.515 [95% CI: 0.305–0.871] at 3 months). Patients with LMR values in Q1 had the highest cumulative death rate. A slightly elevated LMR was also independently relevant to a deduced mortality rate compared to that in Q1 (adjusted HRs in Q2 were 0.471 [95% CI: 0.274–0.809] at 1 month, 0.474 [95% CI: 0.283–0.793] at 3 months, 0.575 [95% CI: 0.361–0.917] at 1 year). Additionally, a higher LMR value was associated with a lower risk of in-hospital infections. Conclusion This study suggests that a lower LMR value is associated with higher risks of in-hospital infections, poor functional outcomes, and follow-up mortality in patients with ICH. However, a slightly elevated LMR value, especially in Q2, relates to a favorable prognosis, which may reflect an inner balance between inflammation and immunodepression and thus provides a promising marker for predicting ICH prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Slightly Elevated Lymphocyte to Monocyte Ratio Predicting Favorable Outcomes in Patients with Spontaneous Intracerebral Hemorrhage

Wang¹,

Wang²,

Zhang³

et al. 2022

JIR

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“… A study by Cheng et al 6 showed that higher monocyte-to-lymphocyte ratio (MLR) was significantly associated with SAP in AIS patients. Another study by Cao et al 7 shows that a high MLR is an independent risk factor for SAP and has a predictive value for severe pneumonia in patients with SAP. Compared to this article, the authors use neutrophils rather than monocytes in the ratio.…”

Section: Dear Editormentioning

confidence: 95%

Comparison of Current Methods with Neutrophil-to-Lymphocyte Ratio in Predicting Stroke-Associated Pneumonia [Letter]

Zou¹,

Qiu²

2022

NDT

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“…A trained neurologist assessed the GCS and NIHSS scores at admission to assess the severity of SICH. The following formulae were used to compute the lymphocyte-based inflammatory index in this study: SIRI ( 21 ), NLR ( 15 ), MLR ( 14 ), and PLR ( 22 ) from the first peripheral blood count at admission.…”

Section: Methodsmentioning

confidence: 99%

“…Routine blood markers (i.e., neutrophils, lymphocytes, and monocytes) are common systemic inflammation and infection markers. In addition, the systemic inflammation response index (SIRI), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR) have better predictive power than conventional inflammatory factors ( 11 – 14 ). Most studies on risk factors for SAP are based on ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Inflammatory response biomarkers nomogram for predicting pneumonia in patients with spontaneous intracerebral hemorrhage

Liu

et al. 2023

Front. Neurol.

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ObjectivesInflammatory response biomarkers are promising prognostic factors to improve the prognosis of stroke-associated pneumonia (SAP) after ischemic stroke. This study aimed to investigate the prognostic significance of inflammatory response biomarkers on admission in SAP after spontaneous intracerebral hemorrhage (SICH) and establish a corresponding nomogram.MethodsThe data of 378 patients with SICH receiving conservative treatment from January 2019 to December 2021 at Taizhou People's Hospital were selected. All eligible patients were randomized into the training (70%, 265) and validation cohorts (30%, 113). In the training cohort, multivariate logistic regression analysis was used to establish an optimal nomogram, including inflammatory response biomarkers and clinical risk factors. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram's discrimination, calibration, and performance, respectively. Moreover, this model was further validated in a validation cohort.ResultsA logistic regression analysis showed that intraventricular hemorrhage (IVH), hypertension, dysphagia, Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), systemic inflammation response index (SIRI), and platelet/lymphocyte ratio (PLR) were correlated with SAP after SICH (P < 0.05). The nomogram was composed of all these statistically significant factors. The inflammatory marker-based nomogram showed strong prognostic power compared with the conventional factors, with an AUC of 0.886 (95% CI: 0.841–0.921) and 0.848 (95% CI: 0.799–0.899). The calibration curves demonstrated good homogeneity between the predicted risks and the observed outcomes. In addition, the model has a significant net benefit for SAP, according to DCA. Also, internal validation demonstrated the reliability of the prediction nomogram. The length of hospital stay was shorter in the non-SAP group than in the SAP group. At the 3-month follow-up, clinical outcomes were worse in the SAP group (P < 0.001).ConclusionSIRI and PLR at admission can be utilized as prognostic inflammatory biomarkers in patients with SICH in the upper brain treated with SAP. A nomogram covering SIRI and PLR can more accurately predict SAP in patients' supratentorial SICH. SAP can influence the length of hospital stay and the clinical outcome.

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Monocyte‐to‐lymphocyte ratio as a predictor of stroke‐associated pneumonia: A retrospective study‐based investigation

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 24 publications

References 33 publications

Slightly Elevated Lymphocyte to Monocyte Ratio Predicting Favorable Outcomes in Patients with Spontaneous Intracerebral Hemorrhage

Slightly Elevated Lymphocyte to Monocyte Ratio Predicting Favorable Outcomes in Patients with Spontaneous Intracerebral Hemorrhage

Comparison of Current Methods with Neutrophil-to-Lymphocyte Ratio in Predicting Stroke-Associated Pneumonia [Letter]

Inflammatory response biomarkers nomogram for predicting pneumonia in patients with spontaneous intracerebral hemorrhage

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