The prediction of neutrophil to lymphocyte ratio for outcomes in ischemic stroke

Abstract

Objective: Neutrophil to lymphocyte ratio (NLR) is a prognostic inflammatory biomarker in patients with cardiovascular disease and hemorrhagic stroke. This metaanalysis aims to evaluate the prognostic values of NLR in predicting clinical outcomes in patients with ischemic stroke.Methods: A literature search was performed using the databases PubMed, EMBASE, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure. Two reviewers independently retrieved papers that met the inclusion criteria. Subgroup analyses were performed using in-hospital mortality, 90-day mortality and 90-day poor outcomes (mRS>2) as the outcome measures.Results: Eight studies with 3855 patients were included in the analysis. An elevated NLR was a strong predictor for in-hospital mortality (OR: 1.05; 95% CI: 1.03-1.07, p<0.001) and for 90-day poor outcomes (OR: 2.28; 95% CI: 1.39-3.73, p<0.001), but not for 90-day mortality (OR: 3.04; 95% CI: 0.74-12.55, p=0.12). After performing subgroup analysis, the NLR was found to predict 90-day mortality with a high (>5) cut-off values (OR: 6.69; 95% CI: 1.70-26.33, p=0.007). The lower cut-off values had no significance (OR: 2.17; 95% CI: 0.43-10.86, p=0.35).Conclusions: A high NLR was significantly associated with higher rates of inhospital mortality and 90-day poor outcome in patients with ischemic stroke, especially with a high mean NLR or high cut-off values. With a high cut-off value (>5), NLR could predict the 90-day mortality after ischemic stroke.

An Elevated Neutrophil-to-Lymphocyte Ratio Predicts In-Hospital Mortality in Stroke Patients: A Prospective Cohort Study

“…Out of the 60 patients, 46 (76.6%) patients survived the hospital stay and were discharged within a week, while 14 (23.3%) patients died within the first week of admission to the hospital. The median baseline NIHSS score was 18 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) among patients who died. The mean age of the patients who survived was 61.06 years (SD=11.24) and that of those who died was 71 years (SD=10.64).…”

“…Elevated NLR values in patients with ischemic stroke have been linked to a higher 30-day mortality rate and an extended duration of hospital stays [ 8 , 13 ]. A meta-analysis of eight studies involving 3855 patients, conducted in 2017, reported that a high cut-off value of NLR (>5) could predict 90-day mortality in ischemic stroke [ 14 ]. Another study conducted in Australia determined that the NLR measured in the first 72 hours of admission was significantly elevated in stroke patients who died during their hospital stay compared to those who survived [ 10 ].…”

“…A higher NLR is associated with a greater chance of developing recurring episodes of ischemic stroke after the initial acute ischemic stroke [ 7 ]. However, the mortality rate is also influenced by other factors, such as age, underlying vascular abnormalities, history of myocardial infarction, and baseline National Institute of Health stroke scale (NIHSS) and Glasgow Coma Scale assessments [ 10 , 14 ].…”