Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease

Abstract

Background: Inflammation plays a role in the pathogenesis of carotid atherosclerosis. Although previous data demonstrated an association between inflammatory biomarkers and stroke, there is no publication reporting the relation of neutrophil to lymphocyte (N/L) ratio with ischemic stroke. We aimed to analyze the predictive ability of N/L ratio in acute ischemic cerebrovascular disease.

Methods: A total of 190 patients including 70 patients with first-ever atherothrombotic acute ischemic stroke (AAIS), 50 patients with transient ischemic attack, and 70 healthy subjects were enrolled in this study. We analyzed the values of white blood cell (WBC), N/L ratio, C-reactive protein (CRP), gamma-glutamyltransferase (GGT), homocysteine (HCY), mean platelet volume (MPV) in patients with ischemic group and compared those with control individuals.

Results: WBC, CRP, HCY, N/L ratio were found to increase significantly in AAIS patients than the controls (P < 0.001). With respect to mortality, there were no significant differences between the values of CRP, GGT, HCY, and MPV in patients with AAIS. However, WBC and N/L ratio values were found to increase significantly in dead patients (P = 0.024 and P = 0.029, respectively). A comparison of receiver operating characteristic curves among WBC, CRP, GGT, HCY, MPV, and N/L ratio variables was made. No significant differences were obtained between area under curve values (P > 0.05). A cut-off value of 4.1 for N/L ratio was detected in predicting mortality with a sensitivity of 66.7% and a specificity of 74.1% (κ = 0.299, P = 0.006).

Conclusions: These findings support the role of N/L ratio as a simple inexpensive and readily available marker of prognosis in acute ischemic stroke.

Keywords: ischemic stroke; neutrophil to lymphocyte ratio; prognosis.

Figure 1

(A) A plot for comparison of ROC curves among WBC, CRP, GGT, HCY, MPV, and N/L variables. AUC values were 0.73 (0.61–0.83), 0.65 (0.53–0.76), 0.56 (0.43–0.68), 0.73 (0.61–0.83), 0.62 (0.50–0.74), 0.74 (0.62–0.84), respectively, and there were not any significant difference between any two AUC values (P > 0.05). (B) A plot to show the determination of the optimal cut‐off value for N/L.