Neutrophil to High-Density Lipoprotein Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Abstract

Background: Hemorrhagic transformation (HT) is one of the most common and severe complications in patients with acute ischemic stroke (AIS). It indicates a poor prognosis in AIS patients. However, the association of neutrophil to high-density lipoprotein ratio (NHR) with HT remains unclear. Purpose: This study examined whether the NHR has a predictive effect on HT in AIS patients and explored the predictive cutoff value of the NHR. Methods: This is a retrospective study and consecutively included AIS patients admitted to the Department of Neurology of the First Affiliated Hospital of Wannan Medical College between December 2019 and January 2022. All subjects had blood samples collected within 24 h of admission, and neutrophil counts and high-density lipoprotein counts were detected. HT was diagnosed with hemorrhage on subsequent magnetic resonance imaging (MRI) or computed tomography (CT) of the brain. Univariate logistic regression analysis was performed to identify confounding factors, and multivariate logistic regression analysis determined the correlation between NHR and HT. Receiver operating characteristic (ROC) curves were used to evaluate the clinical predictive value of NHR. Results: A total of 725 patients were finally included in this study, of which 87 (12%) developed HT. The median NHR value in the HT group was 4.31, which was significantly higher than that in the non-HT group, and the difference was statistically significant [4.31 (3.54-6.24) vs 3.63 (2.68-4.64), p < 0.001]. The binary logistic regression analysis showed that NHR was independently associated with HT in AIS patients (OR: 1.180, 95% CI: 1.036-1.344, p = 0.013). The area under ROC curve (AUC) of NHR for predicting HT in AIS patients was 0.633 (95% CI: 0.567-0.699, p < 0.001), and its optimal cutoff were 3.52. Conclusion:The NHR was a reliable and simple independent predictor of HT in AIS patients.

Correlation analysis of the SIRI, PLR and NLR with the short- term prognosis of acute cerebral infarction

“…Given that in ammatory cells play an important role in the development of IS, researchers have begun to explore ways to improve the prognosis of stroke patients by targeting in ammatory cells to alleviate brain tissue damage. By constructing a mouse model of tethered middle cerebral artery, Hu et al found that suppressing the number of neutrophils in the ischaemic region of acute ischaemic stroke minimised cell death and promoted functional recovery of the nervous system [22] ; Huang et al found that microglial IL-1RA ameliorates brain injury after ischaemic stroke by inhibiting astrocytic CXCL1-mediated neutrophil recruitment [23] ; and AlRuwaili et al demonstrated that inhibition of phosphodiesterase 5 (PDE5) promotes neurological recovery in AIS patients by modulating the brain cyclic adenosine monophosphate (cAMP)/cyclic guanosine monophosphate (cGMP)/nitric oxide (NO) pathways [24] . Currently, studies on reducing the severity of AIS and promoting neurological recovery by alleviating neuroin ammation have been carried out in mouse models, and there is an urgent need for additional researchers to increase their efforts.…”

Association between neutrophil to high-density lipoprotein cholesterol ratio and disease severity in patients with acute biliary pancreatitis

“…Furthermore, we found a linear positive correlation between NHR and the risk of developing non-MAP. NHR is a conventional, inexpensive, and readily available blood indicator and serves as an effective, independent indicator of the severity of various diseases [ 16–18 , 25 ]. Higher NHR values were independently associated with a higher risk of haemorrhagic transformation in patients with acute ischaemic stroke [ 16 ] and with cardiovascular risk in healthy individuals [ 17 ].…”

“…Haematologic inflammation indicators, such as white blood cell (WBC) count, C-reactive protein, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, and systemic inflammatory response index, are independently associated with the severity of ABP [ 12–15 ]. Additionally, the neutrophil to high-density lipoprotein cholesterol ratio (NHR) is associated with the severity of various diseases, including acute ischaemic stroke, cardiovascular disease, and Parkinson’s disease [ 16–18 ]. However, no studies have investigated the association between NHR and ABP severity.…”

Correlations between NLR, NHR, and clinicopathological characteristics, and prognosis of acute ischemic stroke

“…[ 26 , 27 ] In fact, Wei et al reported that NLR might have a greater negative diagnostic value in predicting stroke-associated pneumonia in patients with AIS. [ 28 ] Meanwhile, Zhang et al [ 29 ] found NHR to be a reliable and simple independent predictor of hemorrhagic transformation in patients with AIS. Chen et al [ 16 ] further revealed that high NHR levels are associated with poor prognosis 3 months after intravenous thrombolysis in patients with AIS.…”