Neutrophil-to-lymphocyte ratio in the assessment of early neurological impairment,prognosis and risk of recurrence in pa-tients with acute ischemic stroke
Objective To investigate the value of neutrophil-to-lymphocyte ratio(NLR)in the assessment of early neurological impairment,prognosis and risk of recurrence in patients with acute ischemic stroke(AIS).Methods A total of 236 patients with AIS admitted to Ningbo Medical Center Li Huili Hospital from April 2022 to October 2023 were enrolled.According to the TOAST criteria,patients were classified as large-artery atherosclerosis type(n=151),cardioembolism type(n=30)and small-artery occlusion type(n=55).Gender,age,history of hypertension,diabetes,smoking,drinking,National Institutes of Health stroke scale(NIHSS)score,modified Rankin scale(mRS)score,Essen stroke risk scale(ESRS)score,neutrophil(N),NLR,red cell distribution width(RDW),hypersensitive C-reactive protein(hs-CRP),D-dimer,homocysteine(Hcy),IL-6,IL-10 at admission were compared among AIS patients with different TOAST classification.According to the results of NIHSS,mRS and ESRS scores at admission,univariate and multivariate binary logistic regression were used to analyze the factors affecting the degree of neurological impairment,prognosis and risk of recurrence in AIS patients.ROC curve was used to evaluate the effectiveness of laboratory indicates in predicting the degree of neurological impairment,prognosis and risk of recurrence in patients with AIS.Spearman rank correlation was used to analyze the correlation between NLR and NIHSS,mRS and ESRS scores in patients with AIS.Results There were significant differences in the age,NIHSS score,mRS score,ESRS score,N,NLR,RDW,hs-CRP,D-dimer,Hcy,IL-6 and IL-10 levels among AIS patients with different TOAST types(all P＜0.05).Multivariate analysis showed that NLR was an independent factor affecting the degree of neurological impairment in AIS patients(P＜0.05).NLR,hs-CRP and D-dimer were independent factors influencing the prognosis of neurological function in AIS patients(all P＜0.05).NLR and D-dimer were independent factors influencing the risk of recurrence in AIS patients(both P＜0.05).The area under the curve(AUC)of NLR for predicting degree of neurological impairment in AIS patients was 0.670,taking 2.52 as the best cut-off value,the sensitivity was 0.734 and specificity was 0.528.The AUC of NLR combined with hs-CRP and D-dimer was 0.781,using 0.40 as cut-off value for predicting neurological recovery in AIS patients,the sensitivity and specificity were 0.718 and 0.730,respectively.The AUC of NLR combined with D-dimer level was 0.736,using 0.42 as cut-off value for predicting the risk of recurrence in AIS patients,the sensitivity and specificity were 0.736 and 0.661,respectively.Spearman rank correlation analysis showed that NLR was positively correlated with NIHSS score,mRS score and ESRS score(rs=0.291,0.358,0.277,all P＜0.001).Conclusion NLR has certain clinical value in the assessment of early neurological impairment,prognosis and risk of recurrence in patients with AIS.NLR combined with hs-CRP and D-dimer may effectively improve the evaluation efficiency of neurological prognosis in patients with AIS.
Acute ischemic strokeNeutrophil-to-lymphocyte ratioNational Institutes of Health stroke scaleModified Rankin scaleEssen stroke risk score
万方数据
维普
