Prognostic value of lymphocyte-to-monocyte ratio in acute ischemic stroke: a systematic review and meta-analysis

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Prognostic value of lymphocyte-to-monocyte ratio in acute ischemic stroke: a systematic review and meta-analysis

Chengli Tian^1,2†Yilin Yang^1,2†Jun Wan²Ran Wang²Ke Zhou²Yuanli Li²Wenlong Guo¹Huijun Li²Yu Zhang^1*

• ¹Center for Evidence-Based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
• ²Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China

Background: The findings from studies exploring the prognostic relevance of the lymphocyte-to-monocyte ratio (LMR) in individuals with acute ischemic stroke (AIS) have shown variability. We aimed to conduct a meta-analysis to determine the prognostic significance of LMR in this patient population.

Methods: We carried out a meta-analysis utilizing information from major databases, including PubMed, Embase, and Web of Science until October 26, 2024. Effect sizes, represented as odds ratios (ORs) along with their corresponding 95% confidence intervals (CI), were synthesized employing a random-effects model in Review Manager Version 5.4. To investigate possible sources of variability, we conducted subgroup analyses. Additionally, publication bias was assessed through the use of a funnel plot. Poor functional outcome at 3 months, as indicated via a modified Rankin Scale score of ≥3, was the main outcome. A moderate to severe stroke, determined by a National Institutes of Health Stroke Scale score of ≥6, was the secondary outcome.

Results: Six trials totaling 1,225 individuals were included in our analysis. In AIS patients, we discovered a significant correlation between lower LMR and poorer functional outcome at 3 months, with an OR of 0.63, 95% CI of 0.49 to 0.80, and a p-value of 0.0002. Additionally, lower LMR may be associated with developing moderate to severe stroke, with an OR of 0.89 (95% CI: 0.82–0.97; p = 0.008). In subgroup analyses with an LMR cutoff, a significant association was observed between lower LMR and greater functional impairment in AIS patients, with an odds ratio of 0.74 (95% CI: 0.62–0.88; p = 0.0005) for LMR ≥ 3 and 0.54 (95% CI: 0.47–0.61; p < 0.00001) for LMR < 3. Additionally, when country-stratified, Asian continued to have a significant correlation between worse functional outcome and lower LMR (OR 0.62, 95% CI: 0.50–0.77, p < 0.0001).

Conclusion: This meta-analysis indicated that LMR was a prognostic factor for clinical outcomes in AIS patients.

Introduction

A stroke is characterized by its abrupt onset, representing a sudden neurological disruption resulting from the abrupt cessation of cerebral blood flow, which leads to a wide spectrum of neurological deficits (1). Strokes are generally classified into two main categories: ischemic and hemorrhagic. Of these, ischemic strokes account for approximately 80% of all cases, with an alarmingly high global incidence of over 13.7 million cases annually, leading to around 5.5 million deaths each year (2). Although strokes can affect individuals across all age groups, they primarily affect older adults. However, there has been a concerning rise in the incidence among younger populations (2, 3). Among the different types of stroke, acute ischemic stroke (AIS) is the most common, placing a significant strain on healthcare systems due to its high morbidity and mortality rates, as well as the considerable risks of fatal outcomes and long-term disabling effects (4). Thus, identifying reliable prognostic markers is crucial for informed clinical decision-making and personalized patient care.

Increasing evidence indicates that AIS triggers an inflammatory response (5–7). There is growing interest in the part inflammatory indicators play in the pathophysiology and outcome of AIS. A cost-effective and easily accessible composite indicator of inflammation in cerebrovascular disease, the lymphocyte-to-monocyte ratio (LMR), which was computed by dividing the lymphocyte count by the monocyte count, integrates the prognostic significance of individual lymphocyte and monocyte levels in relation to AIS (8). Previous research has indicated an association between LMR and the severity as well as outcomes of inflammation-related maladies such as myocardial infarction, chronic autoimmune diseases, and peripheral ischemia (9–11).

The link between LMR and adverse outcomes in AIS patients continues to be a subject of debate. Although a number of studies have shown a correlation between AIS patients’ inferior prognosis and lower LMR levels (12–15), others have failed to establish a significant link between LMR and negative clinical outcomes (16). In light of these discrepant results, we carried out this meta-analysis to delve deeper into the relationship between LMR and adverse outcomes among AIS patients.

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