Predicting death and lack of recovery DO NOTHING for survivors! Get them recovered you blithering idiots! The whole idea is to solve stroke to 100% recovery, not these fucking useless predictions! I'd have you all fired!
Is this the same ratio(MLR), just reversed?
Prognostic value of lymphocyte-to-monocyte ratio in acute ischemic stroke: a systematic review and meta-analysis May 2025
The latest here:
Association Between NLR, MLR and Stroke Incidence, All-Cause Mortality Among Low-Income Aging Populations: A Prospective Cohort Study
Received 22 December 2024
Accepted for publication 16 April 2025
Published 28 April 2025 Volume 2025:18 Pages 5715—5726
DOI https://doi.org/10.2147/JIR.S513811
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Ning Quan
Dongjing Liu,1,* Xiaonan Fan,2,* Junwei Wang,3 Ruihui Weng,4 Jun Tu,5– 7 Jinghua Wang,5– 8 Xianjia Ning,5– 8 Yu Zhao4
1Department of Science and Education, Shenzhen Third People’s Hospital and The Second Hospital Affiliated with The Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China; 2National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital and The Second Hospital Affiliated with The Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China; 3Department of Cardiology, Shenzhen Third People’s Hospital and The Second Hospital Affiliated with The Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China; 4Department of Neurology, Shenzhen Third People’s Hospital and The Second Hospital Affiliated with The Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China; 5Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 6Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China; 7Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China; 8Center of Clinical Epidemiology, Shenzhen Third People’s Hospital and The Second Hospital Affiliated with The Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yu Zhao, Department of Neurology, Shenzhen Third People’s Hospital and The Second Hospital Affiliated with The Southern University of Science and Technology, 29 Bulan Road, Longgang District, Shenzhen, Guangdong Province, 518112, People’s Republic of China, Tel +86-755-61222333, Fax +86-755-61238928, Email Dr_zhaoyu_2023@163.com
Objective: This study aimed to assess the association of the Neutrophil-to-Lymphocyte Ratio (NLR) and Monocyte-to-Lymphocyte Ratio (MLR) in predicting stroke incidence and all-cause mortality in low-income elderly populations.
Methods: This prospective cohort study included participants who were middle-aged or elderly individuals from a low-income population in China. Participants were selected into the cohort and complete baseline assessments, which included questionnaire surveys, physical examinations, blood tests, and carotid artery ultrasound evaluations. Cox proportional hazards regression analysis was used to assess the associations of the NLR and MLR with the incidence of stroke and all-cause mortality. The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC-ROC).
Results: A total of 3948 participants were enrolled in the study. Over a median follow-up period of 7 years, 262 participants experienced stroke events and 227 participants died. After adjusting for potential confounding variables, the final model revealed that a higher NLR was significantly associated with an increased risk of stroke (HR: 1.776, 95% CI: 1.250– 2.254, P = 0.001) and all-cause mortality (HR: 1.558, 95% CI: 1.148– 2.116, P = 0.004). Furthermore, a higher MLR was found to be associated with an increased risk of all-cause mortality (HR: 1.397, 95% CI: 1.054– 1.852, P = 0.020), but no significant association was observed between MLR and stroke incidence. ROC analysis revealed that the AUC for NLR in predicting stroke was 0.55 (95% CI: 0.52– 0.59, P=0.005), while the AUC for MLR was 0.58 (95% CI: 0.54– 0.62, P< 0.001). Similarly, the AUC for NLR in predicting all-cause mortality was 0.57 (95% CI: 0.53– 0.61, P< 0.001), and the AUC for MLR was 0.61 (95% CI: 0.57– 0.65, P< 0.001).
Conclusion: These findings indicate that NLR is associated with an increased risk of stroke and all-cause mortality, while higher MLR is associated with all-cause mortality but not with stroke incidence. However, the modest predictive performance of both markers suggests that their clinical utility remains limited. Further research is needed to validate these associations and explore their potential role in comprehensive risk assessment models.
Keywords: NLR, MLR, stroke, all-cause death, low-income population, elderly populations
Introduction
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) identified stroke, a common form of cerebrovascular disease, is the leading cause of mortality and disability worldwide.1 In 2016, stroke accounted for 5.5 million deaths and 116.4 million disability-adjusted life-years (DALYs) globally. The total number of stroke survivors reached 80.1 million, with 13.7 million new cases reported annually.2 This burden is particularly pronounced in China, where over two million new stroke cases are recorded each year, and stroke is associated with the highest number of DALYs lost for any disease in the country.3
Similar situations also occur in other economically underdeveloped regions and countries.4 Moreover, the economic costs of treatment and post-stroke care place significant strain on the healthcare system, society, and families. These challenges highlight the urgent need for the development of low-cost predictors for stroke risk.
Inflammation plays a crucial role in the development and progression of atherosclerosis and cardiovascular disease.5 Several prospective studies have demonstrated that the ratio of white blood cells to their components serves as a readily available and cost-effective inflammatory biomarker with significant prognostic value in cardiovascular disease, chronic kidney disease, critical illnesses and all-cause mortality.6,7 However, whether these leukocyte-related inflammatory markers are associated with stroke incidence and all-cause mortality in middle-aged and elderly people remains limited, especially in economically underdeveloped regions.
Inflammation is also reported to be a key factor in the pathogenesis of stroke and other cerebrovascular diseases. It plays a dual role in the acute and chronic phases of these diseases. In the acute phase, the inflammatory process is triggered by ischemia or vascular injury, leading to the activation of endothelial cells, platelets, and leukocytes. This response leads to the release of proinflammatory cytokines, chemokines, and adhesion molecules, which lead to blood-brain barrier disruption, leukocyte infiltration, and secondary brain damage.8,9 In the chronic phase, persistent low-grade inflammation exacerbates atherosclerosis and plaque instability, which are the main causes of ischemic stroke. Elevated inflammatory markers, such as C-reactive protein (CRP), interleukin 6 (IL-6), and fibrinogen, are associated with increased stroke risk and poor prognosis in patients.8,9 In addition, systemic inflammation is associated with vascular cognitive impairment and progression of recovery after stroke.10–13 Understanding the interplay between inflammation and cerebrovascular disease provides opportunities for therapeutic intervention as well as prognostication. A study showed that NLR is an important risk factor for all-cause mortality and cardiovascular mortality in patients with cardiovascular disease.14 Wang et al showed that NLR is an important indicator to assess the risk of death in people with metabolic syndrome.15 Zhu et al showed that NLR and MLR have clinical value for predicting short-term outcomes in patients with acute ischemic stroke.16 However, previous studies lack a focus on rural low-income populations.
Since people living in countries with low income, poor medical care, and socioeconomic underdevelopment are at greater risk of cerebrovascular disease and other diseases, it is of great significance to identify the relationship between these readily available and inexpensive inflammatory markers and the incidence of cerebrovascular disease and thus prevent occurrence of stroke.
Previous studies have shown that the NLR and MLR have the potential to identify individuals at high risk for various diseases. Current study employed a prospective design to investigate the relationship between lymphocyte-related inflammatory markers (NLR and MLR) and the risks of stroke and all-cause mortality among middle-aged and elderly populations in rural China. Additionally, we evaluated the predictive value of these markers in assessing the risk of cerebrovascular diseases, particularly stroke, as well as overall mortality in this population.
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