J-shaped association of neutrophil-to-lymphocyte ratio with all-cause mortality and linear association with cardiovascular mortality in stroke survivors

Useless, you gave us NOTHING on how to prevent this problem!
J-shaped association of neutrophil-to-lymphocyte ratio with all-cause mortality and linear association with cardiovascular mortality in stroke survivors

Yiqiao Chen^1†Tian Lv^2†Wanyi Lin¹Tianjiao Meng²Yi Sui^3*Shiqin Chen^4*

• ¹Department of Neurology, Qingtian People’s Hospital, Zhejiang, China
• ²Department of Neurology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, China
• ³The Fourth People’s Hospital of Shenyang, China Medical University, Shenyang, China
• ⁴Department of Neurology, Yuhuan Second People's Hospital, Yuhuan, China

Background: The correlation between systemic inflammation and stroke has been well-established. Notably, the neutrophil-to-lymphocyte ratio (NLR) has been linked to poor outcomes and increased short-term mortality in acute ischemic stroke (AIS). This study aims to explore the association between NLR and long-term mortality among stroke survivors.

Methods: This study analyzed data from 1,229 stroke survivors enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. The participants were categorized according to quartiles of NLR level. Multivariate Cox regression and restricted cubic splines (RCS) were applied to evaluate the relationship between NLR and all-cause and cardiovascular disease (CVD) mortality.

Results: Over a median follow-up of 6.41 years, 485 deaths were recorded. After multivariate adjustment, individuals in the highest NLR quartile (Q4) demonstrated significantly higher risks of all-cause mortality (hazard ratio [HR] = 1.58, 95% confidence interval [CI]: 1.06–2.34) and CVD mortality (HR = 1.90, 95% CI: 1.07–3.37) compared to those in the lowest quartile (Q1). RCS analysis revealed a J-shaped relationship between NLR and all-cause mortality and a linear relationship with CVD mortality.

Conclusion: These findings suggest a J-shaped association between NLR and all-cause mortality, along with a linear relationship between NLR and CVD mortality in stroke survivors.

1 Introduction

Stroke, a global health concern, is linked with high disability and mortality rates. Recognized risk factors include alcohol intake, smoking, and hypertension, contributing to stroke mortality (1). Annually, approximately 6 million people worldwide die from stroke, accounting for over 10% of total global mortality (2). In China, a cross-sectional survey across 31 provinces reported age-standardized prevalence and mortality rates of 1,114.8 per 100,000 individuals and 114.8 per 100,000 person-years, respectively (3). The growing aging population has led to a steady rise in stroke incidences, posing an increasing threat to public health.

Previous studies have linked systemic inflammation with increased mortality at 3 months or during hospitalization, as well as symptomatic intracerebral hemorrhage in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis or mechanical thrombectomy (4). Further research has suggested that systemic inflammation serves as a predictor for poor AIS and intracerebral hemorrhage outcomes (4, 5). The neutrophil-to-lymphocyte ratio (NLR), a ratio between neutrophil and lymphocyte counts, is a widely accepted marker for systemic inflammation (6) and is pivotal in evaluating conditions such as AIS, coronary heart disease (CHD), cancer, sepsis, COVID-19 pneumonia, and other types of pneumonia (7). However, limited research has delved into the correlation between NLR and long-term mortality in stroke survivors.

This study utilizes data from the National Health and Nutrition Examination Survey (NHANES) to investigate the relationship between NLR levels and long-term all-cause and cardiovascular disease (CVD) mortality in stroke survivors.

More at link.