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. 2024 Jan 8;16(1):e51841.
doi: 10.7759/cureus.51841. eCollection 2024 Jan.

Neutrophil Lymphocyte Ratio as a Predictor of Stroke Severity in Type 2 Diabetes Mellitus: A Single-Center Study

Karan Pal Singh  1 , Ramandeep Singh  2 , Tanveer Singh  3 , Sukhmandeep Kaur  4 , Tinish Mittal  4 , Meena Goyal  4 , Pugazhendi Inban  5 , Agaba Barnett James Musiime  6 , Madiha D Haseeb  7 , Aadil Khan  8   9   10
Affiliations

Neutrophil Lymphocyte Ratio as a Predictor of Stroke Severity in Type 2 Diabetes Mellitus: A Single-Center Study

Karan Pal Singh et al. Cureus. .

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) is associated with various microvascular and macrovascular complications. Stroke, being a vascular complication, is associated with severe morbidity and mortality. Neutrophil lymphocyte ratio (NLR), a crude, inexpensive, and rather easily available modality to detect inflammation, has been utilized to find the extent of inflammation in type 2 diabetes mellitus patients. In this study, we find the effect of hemoglobin A1c (HbA1c) on NLR and the effect of NLR on stroke severity index.

Aims and objectives: This study aims to determine the use of the NLR in predicting stroke severity in a type 2 diabetes mellitus patient.

Materials and methods: This study is an observational cross-sectional study. A total of 400 patients were enrolled, all of whom had type 2 diabetes mellitus, with 200 of them diagnosed with an ischemic stroke. The National Institute of Health stroke scale (NIHSS) was used to standardize stroke severity and NLR was calculated from differential counts.

Results: The mean NLR for patients with type 2 diabetes mellitus was 3.87 ± 0.76 (mean ± SD), while for those with type 2 diabetes mellitus and stroke, it was 7.89 ± 1.29 (mean ± SD), with a statistically significant p-value < 0.001. Additionally, for every 1 unit increase in HbA1c, the NLR increased by 0.38 in type 2 diabetes mellitus patients and 0.86 in type 2 diabetes mellitus patients with stroke. Furthermore, each 1-unit increase in NLR corresponded to a rise of 0.80 in the stroke severity index.

Conclusion: The study shows a significant correlation between NLR in type 2 diabetes mellitus patients and stroke in type 2 diabetes mellitus patients. Also, it shows the significance of NLR in predicting stroke severity.

Keywords: national institute of health stroke scale (nihss); “hba1c”; “ischemic stroke”; “stroke severity”; “type 2 diabetes mellitus”.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Scatter figure showing a correlation between HbA1c (%) and NLR in the case group.
The X-axis represents HbA1c levels, and the Y-axis represents neutrophil-to-lymphocyte ratio. Each data point reflects the relationship between HbA1c and NLR. The analysis indicates that for every 1.0% increase in HbA1c, there is a corresponding increase in NLR by 0.86 (p-value < 0.001).
Figure 2
Figure 2. Scatter figure showing a correlation between HbA1c (%) and NLR in the control group.
The X-axis represents HbA1c levels, and the Y-axis represents neutrophil-to-lymphocyte ratio. Each data point illustrates the relationship between HbA1c and NLR. The analysis reveals that for every 1.0% increase in HbA1c, there is a corresponding increase in NLR by 0.38 (p-value < 0.001).
Figure 3
Figure 3. Scatter figure showing a correlation between stroke severity index and NLR.
The X-axis represents stroke severity index, and the Y-axis represents neutrophil-to-lymphocyte ratio. Each data point illustrates the relationship between stroke severity index and NLR. The analysis indicates that for every 1 unit increase in NLR, there is a corresponding 0.80 increase in stroke severity index (Spearman’s rank correlation coefficient, rho=0.23, p-value = 0.001).
See this image and copyright information in PMC

References

    1. The rise of noncommunicable diseases in Kenya: an examination of the time trends and contribution of the changes in diet and physical inactivity. Onyango EM, Onyango BM. J Epidemiol Glob Health. 2018;8:1–7. - PMC - PubMed
    1. Direct medical cost of type 2 diabetes mellitus and its associated complications in Indonesia. Hidayat B, Ramadani RV, Rudijanto A, Soewondo P, Suastika K, Siu Ng JY. Value Health Reg Issues. 2022;28:82–89. - PubMed
    1. Epidemiology of type 2 diabetes - global burden of disease and forecasted trends. Khan MA, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. J Epidemiol Glob Health. 2020;10:107–111. - PMC - PubMed
    1. Association between hemoglobin A1c and acute ischemic stroke among patients with type-2 diabetes: a case-control study. Chaveepojnkamjorn W, Boorasri W, Viwatwongkasem C, Siri S, Krienkaisakda W. https://doi.org/10.1007/s13410-020-00806-7 Int J Diabetes Dev Ctries. 2020;40:555–560.
    1. Neutrophil-to-lymphocyte ratio is a prognostic marker in acute ischemic stroke. Xue J, Huang W, Chen X, Li Q, Cai Z, Yu T, Shao B. J Stroke Cerebrovasc Dis. 2017;26:650–657. - PubMed

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