Unlocking Insights: How Neutrophil Lymphocyte Ratio Predicts Early Neurological Deterioration

Unlocking Insights: How Neutrophil Lymphocyte Ratio Predicts Early Neurological Deterioration

November 16, 2024 Catherine Williams - Chief Editor Health

Introduction

This study investigates the relationship between the Neutrophil-to-Lymphocyte Ratio (NLR) and Early Neurological Deterioration (END) in patients with acute infarct of the anterior circulation.

Methods

Patients

We analyzed patients admitted to Jinling Hospital within 24 hours of symptom onset for their first acute ischemic stroke. Inclusion criteria required evidence of new focal neurologic deficits where relevant lesions were detected via diffusion weighted imaging (DWI) or computed tomography (CT). We excluded patients diagnosed with infection, using corticosteroids, having cancer or immune system disease, or with incomplete medical records.

Data Collection

We collected demographic and clinical data, including age, sex, vascular risk factors, vital signs, time from stroke onset to admission, hospital duration, and laboratory parameters. NLR was calculated as the ratio of neutrophil count to lymphocyte count. Etiological classification of stroke followed the TOAST criteria. NIHSS scores were recorded at admission, 72 hours post-admission, and upon discharge. Functional impairment was evaluated using the modified Rankin Scale (mRS) during discharge.

Treatment and Neurological Assessment

Patients treated with tPA or endovascular therapy were excluded. We implemented guideline-based treatments and evaluated END as an increase of ≥2 points in NIHSS scores after 72 hours of admission.

Statistical Analysis

We presented continuous data as mean ± standard deviation or median with interquartile ranges. Categorical data were expressed as frequencies and percentages. We used logistic regression to analyze the correlation between END and other factors, presenting results as odds ratios with confidence intervals. ROC analysis determined the optimal cut-off values for NLR.

Results

In this study, 228 patients were included. The average age was 61 years, with 67% being male. A total of 64 patients (28.1%) experienced END. Patients with END had a higher NIHSS score at admission compared to those without END (median NIHSS score 5 vs. 4; p=0.011). The END group also had a higher median NLR (3.8 vs. 2.4; p=0.006) and lower lymphocyte counts (mean 1.6 vs. 1.9; p=0.006).

Multivariate logistic regression indicated that an NLR greater than 2.65 (OR, 4.019; p=0.038) and admission serum glucose (OR, 1.178; p=0.025) were independent predictors of END. An NLR above 2.65 made patients nearly 4 times more likely to develop END. The ROC curve indicated that the optimal cut-off for NLR to predict END was 2.68, with 75% sensitivity and 60.98% specificity (AUC = 0.72; p < 0.001).

We also found that patients in the high NLR group (NLR > 2.65) had a longer hospital stay (median 12 vs. 4; p < 0.001).

Discussion

This study defines END as an increase of NIHSS scores by ≥2 points. Definitions of END may vary, potentially affecting results. Limitations include retrospective data collection and the small sample size. Future studies should analyze factors such as infarct size.

In conclusion, NLR at admission significantly correlates with END in acute ischemic stroke patients with anterior circulation lesions. NLR is an accessible biomarker that can effectively indicate the risk of END following acute infarction.