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Meta-Analysis
. 2022 Mar 12:2022:1983455.
doi: 10.1155/2022/1983455. eCollection 2022.

The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis

Shokoufeh Khanzadeh  1 , Brandon Lucke-Wold  2 , Fatemeh Eshghyar  3 , Katayoun Rezaei  4 , Alec Clark  5
Affiliations
Meta-Analysis

The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis

Shokoufeh Khanzadeh et al. Dis Markers. .

Abstract

Ischemic and hemorrhagic strokes have multiple downstream consequences for patients. One of the most critical is poststroke infection (PSI). The goal of this systematic review and meta-analysis was to critically evaluate the literature regarding the use of the neutrophil to lymphocyte ratio (NLR) as a reliable means to detect early PSI development, particularly poststroke pneumonia (PSP) development to help clinicians institute early interventions and improve outcomes. The following were the inclusion criteria: (1) cross-sectional, case-control, and cohort studies; (2) studies comparing NLR data from PSI or PSP patients to controls; and (3) studies with a control group of stroke patients without infection. There was not any language or publication preference. The Newcastle-Ottawa Scale was used by two writers to assess the quality of the included studies. We assessed the certainty of the associations with GRADE methods. Web of Science, PubMed, and Scopus were searched, and 25 studies were included in the qualitative review. Among them, 15 studies were included in the meta-analysis. Standardized mean difference (SMD) was reported with a 95% confidence interval (CI) for the NLR levels. Patients with PSI had significantly higher NLR levels than stroke patients without infection (SMD = 1.08; CI 95% = 0.78-1.39, P value < 0.001). In addition, the NLR levels of the stroke patients with pneumonia were significantly higher than those without pneumonia (SMD = 0.98; CI 95% = 0.81-1.14, P value < 0.001). However, data extracted from the qualitative review suggested that NLR could not predict urinary tract infection, sepsis, or ventriculitis in stroke patients. Our study indicated that NLR could be recommended as an inexpensive biomarker for predicting infection, particularly pneumonia, in stroke patients. It can help clinicians institute early interventions that can reduce PSI and improve outcomes.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of search and study selection.
Figure 2
Figure 2
Meta-analysis of differences in NLR level between PSI and NPSI patients.
Figure 3
Figure 3
Subgroup analysis of differences in NLR level between PSI and NPSI according to study design.
Figure 4
Figure 4
Meta-analysis of differences in NLR level between PSP and NPSP patients.
Figure 5
Figure 5
Subgroup analysis of differences in NLR level between PSP and NPSP according to study design.
Figure 6
Figure 6
Subgroup analysis of differences in NLR level between PSP and NPSP according to study location.
Figure 7
Figure 7
(a) Publication bias assessment based on Funnel plot and Egger's test in data of PSI. (b) Publication bias in data of PSP.
See this image and copyright information in PMC

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References

    1. Angkananard T., Anothaisintawee T., McEvoy M., Attia J., Thakkinstian A. Neutrophil lymphocyte ratio and cardiovascular disease risk: a systematic review and meta-analysis. BioMed Research International . 2018;2018:11. doi: 10.1155/2018/2703518.2703518 - DOI - PMC - PubMed
    1. Jamali S. A., Turnbull M. T., Kanekiyo T., et al. Elevated neutrophil-lymphocyte ratio is predictive of poor outcomes following aneurysmal subarachnoid hemorrhage. Journal of Stroke and Cerebrovascular Diseases . 2020;29(4):p. 104631. doi: 10.1016/j.jstrokecerebrovasdis.2019.104631. - DOI - PubMed
    1. Lux D., Alakbarzade V., Bridge L., et al. The association of neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio with 3-month clinical outcome after mechanical thrombectomy following stroke. Journal of Neuroinflammation . 2020;17(1):p. 60. doi: 10.1186/s12974-020-01739-y. - DOI - PMC - PubMed
    1. Kakhki R. D., Dehghanei M., ArefNezhad R., Motedayyen H. The predicting role of neutrophil- lymphocyte ratio in patients with acute ischemic and hemorrhagic stroke. Journal of Stroke and Cerebrovascular Diseases . 2020;29(11):p. 105233. doi: 10.1016/j.jstrokecerebrovasdis.2020.105233. - DOI - PubMed
    1. Guldolf K., Vandervorst F., Gens R., Ourtani A., Scheinok T., De Raedt S. Neutrophil-to-lymphocyte ratio predicts delirium after stroke. Age and Ageing . 2021;50(5):1626–1632. doi: 10.1093/ageing/afab133. - DOI - PubMed