Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio in stroke-associated pneumonia: a systematic review and meta-analysis

Zawiah, Mohammed; Khan, Amer Hayat; Farha, Rana Abu; Abubakar, Usman; Bitar, Ahmad Naoras

doi:10.1080/03007995.2023.2174327

Cited by 11 publications

(8 citation statements)

References 47 publications

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“…Noteworthy, a consensus on the definition of SII—and of the precise NLR cut-off for defining it—is still lacking. Possible markers of SII are represented by absolute lymphocytopenia, lymphocyte-to-monocyte ratio (LMR), reduction of monocytes HLA-DR expression, platelet-to-lymphocyte ratio (PLR) 7 , 8 , 13 , 18 , 21 – 23 . Park et al showed that a low LMR was a negative predictor of good clinical outcomes (mRS 0–1 at 3 months), and it was associated to a higher predisposition to infectious complications 21 .…”

Section: Discussionmentioning

confidence: 99%

The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting

Vaghi,

Morotti,

Piella

et al. 2024

Sci Rep

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Stroke affects the interconnection between the nervous and immune systems, leading to a down-regulation of immunity called stroke-induced immunosuppression (SII). The primary aim of this study is to investigate SII role as a predictor of functional, neurological, and motor outcomes in the neurorehabilitation setting (NRB). We conducted a prospective observational study enrolling post-acute stroke patients hospitalized for neurorehabilitation. At NRB admission (T0) and discharge (T1), we assessed presence of SII (defined by a neutrophil-to-lymphocyte ratio ≥ 5) and we evaluated functional independence (Functional Independence Measure-FIM, Barthel Index-BI), motor performances (Tinetti Score, Hauser Ambulation Index) and neurological impairment (NIHSS). We enrolled 96 patients (45.8% females, 70.6 ± 13.9 years, 88.5% ischemic stroke). At T0, 15.6% of patients (15/96) had SII. When compared to immunocompetent patients (IC), the SII group was characterized by worse baseline functional independence, motor performances and neurological disability. The same was confirmed at T1 (FIM p = 0.012, BI p = 0.007, Tinetti p = 0.034, NIHSS p = 0.001). Neurological disability demonstrated a less pronounced improvement in SII (ΔNIHSS: SII: − 2.1 ± 2.3 vs. IC: − 3.1 ± 2.5, p = 0.035). SII group presented a higher percentage of infectious complications during the neurorehabilitation period (SII 80% vs. IC 25.9%; p = 0.001). SII may represent a negative prognostic factor in the neurorehabilitation setting. SII patients were characterized by poorer functional, motor, neurological performances and higher risk of infectious complications. ClinicaTrial registration: NCT05889169.

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Section: Discussionmentioning

confidence: 99%

The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting

Vaghi,

Morotti,

Piella

et al. 2024

Sci Rep

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“…In our study, PLR-CRP and PMR demonstrated acceptable performances in differentiating between these two diseases. In a meta-analysis of 12 studies with 6.302 patients, they showed the association of NLR, MLR, and PLR with stroke-associated pneumonia 13 . Chen et al 26 investigated the diagnostic value of PLR in TB patients with COPD, reporting a sensitivity of 92,4% and specificity of 84,5% in discriminating between TB and other causes of exacerbation.…”

Section: Discussionmentioning

confidence: 99%

“…The assessment of cell counts and the relationships between different types of blood cells has been proposed to provide useful and easily accessible information for distinguishing between these two conditions 9,11 . An elevated monocyte/lymphocyte ratio (MLR) has been suggested as an indicative marker of tuberculosis, while a low value may indicate bacterial pneumonia 12,13 . Additionally, it has been found that the neutrophil/mast cell ratio (NMR) is higher in tuberculosis than in pneumonia 14 , suggesting that these parameters could reflect a specific inflammatory and immunological state according to the type of infection 15 .…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, it has been found that the neutrophil/mast cell ratio (NMR) is higher in tuberculosis than in pneumonia 14 , suggesting that these parameters could reflect a specific inflammatory and immunological state according to the type of infection 15 . These cellular indices have also been compared to other inflammatory markers, with findings indicating, among other things, that the neutrophil/lymphocyte ratio (NLR) may be superior to C-reactive protein (CRP) in predicting bacteremia in emergency department 16 , and that NLR, MLR, and platelet/ lymphocyte ratio (PLR) may be associated with stroke-related pneumonia 13 . However, information comparing the performance of these indices and their relationship with other inflammatory markers, such as CRP, remains limited.…”

Section: Introductionmentioning

confidence: 99%

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Blood cell markers and acute phase reactants as a strategy to differentiate between pulmonary tuberculosis and community-acquired pneumonia: a retrospective cohort study

Bastidas Goyes,

Tuta-Quintero,

Arsanios

et al. 2023

Infect

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Objective: To determine the diagnostic yields of the different types of cell indices alone or in combination with C-reactive-protein(CRP) to distinguish between Pulmonary-tuberculosis(PT) and community-acquired-pneumonia(CAP). Methods: A retrospective cohort study was conducted in a high-complexity care center in Colombia, evaluating different types of cell indices in PT and CAP patients. A-receiver-operating-characteristic (ROC)-curve was plotted, and the area-under ROC-curve was calculated for each of these indices, as well as for CRP and procalcitonin values.Results: A total of 544 subjects were included in the final analysis. Of these, 270(49,6%) were diagnosed with PT and 274(50,4%) with CAP. Patients with CAP had significantly higher levels of leukocytes, neutrophils, monocytes, hemoglobin, hematocrit, and platelets than patients with PT (p < 0,05for-all-comparisons). Procal-citonin did not show significant differences between the groups (p=0,061). CRP has the highest ROC-curve for differentiating between PT and CAP, with ROC-curve of 0,76 (95%CI:0,71-0,88) and 0,75 (95%CI:0,71-0,80), respectively. Procalcitonin did not show discriminatory power for these two diseases, with an ROC-curve of 0,60 (95%CI:0,50-0,71). Conclusion: CRP and blood-cell-markers were the best markers to differentiate between patients with PT and CAP. The performance of these markers was acceptable, suggesting that they could be useful in clinical setting for suspected tuberculosis or CAP.

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“…Some of these inflammatory biomarkers have demonstrated they are associated with SAP and superior predictive value compared to conventional inflammatory biomarkers. [12][13][14][15] Studies have identified some of the emerging immune markers for predicting other diseases, [16][17][18] but they have not been used in predicting SAP.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Predictive Value of Inflammatory Biomarkers for the Risk of Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke

Li,

Luo,

Chen

et al. 2023

CIA

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To investigate the predictive value of various inflammatory biomarkers in patients with acute ischemic stroke (AIS) and evaluate the relationship between stroke-associated pneumonia (SAP) and the best predictive index. Patients and Methods: We calculated the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-tolymphocyte ratio (MLR), prognostic nutritional index (PNI), systemic inflammation response index (SIRI), systemic immune inflammation index (SII), Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS), and prognostic index (PI). Variables were selectively included in the logistic regression analysis to explore the associations of NLR, PLR, MLR, PNI, SIRI, SII, GPS, mGPS, and PI with SAP. We assessed the predictive performance of biomarkers by analyzing receiver operating characteristic (ROC) curves. We further used restricted cubic splines (RCS) to investigate the association. Next, we conducted subgroup analyses to investigate whether specific populations were more susceptible to NLR. Results: NLR, PLR, MLR, SIRI, SII, GPS, mGPS, and PI increased significantly in SAP patients, and PNI was significantly decreased. After adjustment for potential confounders, the association of inflammatory biomarkers with SAP persisted. NLR showed the most favorable discriminative performance and was an independent risk factor predicting SAP. The RCS showed an increasing nonlinear trend of SAP risk with increasing NLR. The AUC of the combined indicator of NLR and C-reactive protein (CRP) was significantly higher than those of NLR and CRP alone (DeLong test, P<0.001). Subgroup analyses suggested good generalizability of the predictive effect. Conclusion: NLR, PLR, MLR, PNI, SIRI, SII, GPS, mGPS, and PI can predict the occurrence of SAP. Among the indices, the NLR was the best predictor of SAP occurrence. It can therefore be used for the early identification of SAP.

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Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio in stroke-associated pneumonia: a systematic review and meta-analysis

Cited by 11 publications

References 47 publications

The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting

The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting

Blood cell markers and acute phase reactants as a strategy to differentiate between pulmonary tuberculosis and community-acquired pneumonia: a retrospective cohort study

Comparison of the Predictive Value of Inflammatory Biomarkers for the Risk of Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke

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