Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Potential Predictors of Prognosis in Acute Ischemic Stroke

 I see absolutely no use for this. These predictions are based upon the complete failure of recovery currently. YOUR JOB IS TO CHANGE THOSE FAILURES TO RECOVERY.  GET THERE!

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Potential Predictors of Prognosis in Acute Ischemic Stroke

Cuiping Chen^†, Lei Gu^†, Luyun Chen, Wangwang Hu, Xiaowen Feng, Fengzhen Qiu, Zijian Fan, Qitao Chen, Jiayou Qiu and Bei Shao^*

• Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

Objective: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been emerging as the novel inflammatory biomarkers for determining the prognosis of various diseases. This study aimed to investigate the individual and joint effects of NLR and PLR on functional outcomes of acute ischemic stroke (AIS).

Methods: Our study involved 448 eligible patients with first-ever AIS. Clinical and laboratory data were collected on admission within 72 h from stroke onset. Unfavorable functional outcome was defined as a modified Rankin Scale score of 3–6 at 3 months after AIS. Cox proportional hazard model and spline regression models was used to estimate the effect of NLR and PLR on risk of adverse outcomes after the last patient who completed a 3-months follow-up was enrolled.

Results: After adjusting confounders, NLR were significantly associated with the unfavorable functional outcomes (P-trend < 0.001). So were PLR (P-trend < 0.001). NLR was discovered to have higher predictive value than PLR (AUC = 0.776, 95%CI = 0.727–0.825, P < 0.001; AUC = 0.697, 95%CI = 0.641–0.753, P < 0.001). The optimal cutoff values for NLR and PLR was 3.51 and 141.52, respectively. Stratified analysis performed by cox proportional hazard model showed that high level of NLR and PLR (NLR ≥ 3.51, PLR ≥ 141.52) presented the highest risk of unfavorable functional outcomes (adjusted HR, 3.77; 95% CI: 2.38–5.95; P < 0.001). Followed by single high level of NLR (adjusted HR, 2.32; 95% CI: 1.10–4.87; P = 0.027). Single high level of PLR (NLR < 3.51, PLR ≥ 141.52) also showed higher risk than low level of the combination, but it did not reach statistical significance (adjusted HR, 1.42; 95% CI: 0.75–2.70; P = 0.285). No obvious additive [relative excess risk due to interaction (RERI) not significant] or multiplicative (adjusted HR, 0.71; 95%CI: 0.46–1.09; P = 0.114) interaction was found between the effects of NLR and PLR on the risk of unfavorable functional outcomes.

Conclusion: This study demonstrated that both NLR and PLR were independent predictors of 3-months functional outcomes of AIS. They may help to identify high-risk patients more forcefully when combined together.

Introduction

Stroke, the second leading cause of deaths and the third main malady giving rise to disability worldwide, has brought about a major drain on public health-care funding (1). The most common subtype of stroke is ischemic stroke, accounting for 80% of all (2). As China has the highest number of stroke cases in the world with its incidence and prevalence escalating and sprawling over the past decade (3), long-term care of the patients laid a immeasurably huge burden on thousands relatives of patients and caregivers. For this reason, identifying biomarkers for predicting ischemic stroke and accurately evaluating its prognosis is salutary and truly preoccupying to the families.

Post-ischemic inflammation plays an important role in various stages of cerebral ischemic injury, resulting from stagnant blood flow, activation of intravascular leukocytes and release of pro-inflammatory mediators from the ischemic endothelium, platelet granules, and brain parenchyma (4, 5). Numerous studies confirmed that inflammatory response aggravated ischemic brain damage and neurological dysfunction (4, 6, 7). Previous researches suggested that leukocytosis on admission was associated with stroke severity and poor clinical outcomes in acute ischemic stroke (AIS) patients (8). High neutrophil count and low lymphocyte count were regarded as correlation factors of unfavorable functional outcomes of acute cerebral infarction (9). Although the relativity between an increasing platelet count and clinical prognosis remained to be uncertain, it was confirmed that platelets acted as a pivotal role in thrombogenesis and inflammation (5, 10).

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as newfound and inexpensive biomarkers in systematic inflammation were proved to possess diagnostic and predictive capabilities in multiple diseases recently (11–13). Their application in cerebrovascular diseases have been spotlighted by many. Xue et al. found that NLR in patients with AIS was related to stroke severity, short-term functional prognosis and recurrence of cerebral infarction (14). Kocaturk et al. believed that NLR could portend short-term mortality in patients with AIS (15). Altintas et al. elucidated that high PLR augmented the infarct volume and the incidence of undesirable prognosis in AIS patients during 3-years follow up (16). Lately, The joint application of NLR and PLR for predicting clinical prognosis has been universally applied to patients with cancer, coronary artery disease, and subarachnoid hemorrhage (17–19). However, to the best of our knowledge, there has been no data supporting the significance of the joint effects of NLR and PLR on short-term functional outcomes of AIS. Therefore, the aim of this study was to investigate the individual and joint prognostic value of NLR and PLR in acute ischemic stroke (AIS).