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The relationship among neutrophil to lymphocyte ratio, stroke territory, and 3-month mortality in patients with acute ischemic stroke

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Abstract

Background

Stroke therapy options have focused on limiting the infarct volume. Neutrophil to lymphocyte ratio (NLR) can be valuable to detect the patients that required intensive treatment at early stage by predicting infarct volume. The aim of this study is to evaluate the relationship between NLR and infarct volume according to the stroke territory, and to determine the prognostic value of NLR for predicting 3-month mortality in acute ischemic stroke (AIS) patients.

Methods

A total of 107 patients with AIS were enrolled and followed up 3 months in terms of mortality. Study population was divided into two groups according to the stroke territory: anterior circulating stroke (ACS) and posterior circulating stroke (PCS). All patients underwent magnetic resonance imaging. The complete blood count and venous blood samples were obtained from the patients on admission to the emergency department.

Results

There were no difference between ACS and PCS groups regarding baseline characteristics and co-morbid diseases. Also, C-reactive protein and NLR were similar between two groups. In correlation analyses, infarct volume was significantly correlated with CRP and NLR in ACS (r = 0.350, p = 0.001 and r = 0.482, p ≤ 0.001, respectively), but not correlated with infarct volume in PCS. Also, NLR was correlated with NIHHS in only ACS group (r = 0.326, p = 0.002). Multivariate analysis showed that NLR was the only independent predictor of 3-month mortality (OR 1.186, 95% CI 1.032–1.363, p = 0.016).

Conclusion

NLR is significantly correlated with ACS infarct volume, but not with PCS infarct volume in AIS. Also, NLR was an independent predictor of 3-month mortality in AIS patient.

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References

  1. Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, Creager MA, Culebras A, Eckel RH, Hart RG, Hinchey JA, Howard VJ, Jauch EC, Levine SR, Meschia JF, Moore WS, Nixon JV, Pearson TA, American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council for High Blood Pressure Research, Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research (2011) Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:517–584

    Article  Google Scholar 

  2. Li W, Yin Q, Xu G, Liu X (2016) Treatment strategies for acute ischemic stroke caused by carotid artery occlusion. Interv Neurol 5(3–4):148–156

    Article  Google Scholar 

  3. Libby P, Ridker PM, Maseri A (2002) Inflammation and atherosclerosis. Circulation 105:1135–1143

    Article  CAS  Google Scholar 

  4. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, Renlund DG, Muhlestein JB, Intermountain Heart Collaborative Study Group (2005) Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 45:1638–1643

    Article  Google Scholar 

  5. Buck BH, Liebeskind DS, Saver JL, Bang OY, Yun SW, Starkman S, Ali LK, Kim D, Villablanca JP, Salamon N, Razinia T, Ovbiagele B (2008) Early neutrophilia is associated with volume of ischemic tissue in acute stroke. Stroke 39:355–360

    Article  Google Scholar 

  6. Xue J, Huang W, Chen X, Li Q, Cai Z, Yu T, Shao B (2017) Neutrophil-to-lymphocyte ratio is a prognostic marker in acute ischemic stroke. J Stroke Cerebrovasc Dis 26(3):650–657

    Article  Google Scholar 

  7. Tokgoz S, Kayrak M, Akpinar Z, Seyithanoğlu A, Güney F, Yürüten B (2013) Neutrophil lymphocyte ratio as a predictor of stroke. J Stroke Cerebrovasc Dis 22:1169–1174

    Article  Google Scholar 

  8. Dorňák T, Král M, Hazlinger M, Herzig R, Veverka T, Buřval S, Šaňák D, Zapletalová J, Antalíková K, Kaňovský P (2015) Posterior vs. anterior circulation infarction: demography, outcomes, and frequency of hemorrhage after thrombolysis. Int J Stroke 10:1224–1228

    Article  Google Scholar 

  9. Stroke-Recommendations on stroke prevention, diagnosis, and therapy (1989) Report of the WHO task force on stroke and other cerebrovascular disorders. Stroke 20:1407–1431

    Article  Google Scholar 

  10. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al (1993) Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial: TOAST trial of org 10172 in acute stroke treatment. Stroke 24:35–41

    Article  Google Scholar 

  11. Sims JR, Gharai LR, Schaefer PW, Vangel M, Rosenthal ES, Lev MH et al (2009) ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology 2:2104–2110

    Article  Google Scholar 

  12. Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

    Article  CAS  Google Scholar 

  13. Worthmann H, Tryc AB, Deb M, Goldbecker A, Ma YT, Tountopoulou A, Lichtinghagen R, Weissenborn K (2010) Linking infection and inflammation in acute ischemic stroke. Ann N Y Acad Sci 1207:116–122

    Article  CAS  Google Scholar 

  14. Wang Q, Tang XN, Yenari MA (2007) The inflammatory response in stroke. J Neuroimmunol 184:53–68

    Article  CAS  Google Scholar 

  15. Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, Hacke W, CAPRIE Investigators (2004) CAPRIE investigators. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke 35:1147–1152

    Article  Google Scholar 

  16. Kim J, Song TJ, Park JH, Lee HS, Nam CM, Nam HS, Kim YD, Heo JH (2012) Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis 222:464–467

    Article  CAS  Google Scholar 

  17. Hallenbeck JM (1996) Significance of the inflammatory response in brain ischemia. Acta neurochir (Suppl) 66:27–31

    CAS  Google Scholar 

  18. Garau A, Bertini R, Colotta F, Casilli F, Bigini P, Cagnotto A et al (2005) Neuroprotection with the CXCL8 inhibitor repertaxin in transient brain ischemia. Cytokine 30:125–131

    Article  CAS  Google Scholar 

  19. Chiu NL, Kaiser B, Nguyen YV, Welbourne S, Lall C, Cramer SC (2016) The volume of the spleen and its correlates after acute stroke. J Stroke Cerebrovasc Dis 25(12):2958–2961

    Article  Google Scholar 

  20. Qun S, Tang Y, Sun J, Liu Z, Wu J, Zhang J, Guo J, Xu Z, Zhang D, Chen Z, Hu F, Xu X, Ge W (2017) Neutrophil-to-lymphocyte ratio predicts 3-month outcome of acute ischemic stroke. Neurotox Res 31:444–452

    Article  Google Scholar 

  21. Zhang J, Ren Q, Song Y, He M, Zeng Y, Liu Z, Xu J (2017) Prognostic role of neutrophil-lymphocyte ratio in patients with acute ischemic stroke. Medicine (Baltimore) 96(45):e8624

    Article  Google Scholar 

  22. Zhao L, Dai Q, Chen X, Li S, Shi R, Yu S, Yang F, Xiong Y, Zhang R (2016) Neutrophil-to-lymphocyte ratio predicts length of stay and acute hospital cost in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 25:739–744

    Article  Google Scholar 

  23. Söderholm M, Borné Y, Hedblad B, Persson M, Engström G (2015) Red cell distribution width in relation to incidence of stroke and carotid atherosclerosis: a population-based cohort study. PLoS One 10(5):e0124957

    Article  Google Scholar 

  24. Arévalo-Lorido JC, Carretero-Gómez J, Álvarez-Oliva A, Gutiérrez-Montaño C, Fernández-Recio JM, Najarro-Díez F et al (2013) Mean platelet volume in acute phase of ischemic stroke, as predictor of mortality and functional outcome after 1 year. J Stroke Cerebrovasc Dis 22:297–303

    Article  Google Scholar 

  25. Yoo AJ, Chaudhry ZA, Nogueira RG, Lev MH, Schaefer PW, Schwamm LH, Hirsch JA, González RG (2012) Infarct volume is a pivotal biomarker after intra-arterial stroke therapy. Stroke 43:1323–1330

    Article  CAS  Google Scholar 

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Acknowledgments

The authors thank the patients and their caregivers for collaboration.

Funding

The authors received no financial support for the research or authorship of this article.

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Authors and Affiliations

  1. Department of Neurology, Harran University School of Medicine Hospital, Sanliurfa, Turkey

    Ozcan Kocaturk & Mehtap Kocaturk

  2. Department of Cardiology, Harran University School of Medicine Hospital, Sanliurfa, Turkey

    Feyzullah Besli, Fatih Gungoren & Zulkif Tanriverdi

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  1. Ozcan Kocaturk
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  2. Feyzullah Besli
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  4. Mehtap Kocaturk
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Corresponding author

Correspondence to Feyzullah Besli.

Ethics declarations

The study was in compliance with the Declaration of Helsinki principles and was approved by the Institutional Review Boards and Ethical Committee, and all patients involved gave their written informed consent.

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The authors declare that they have no conflict of interest.

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Kocaturk, O., Besli, F., Gungoren, F. et al. The relationship among neutrophil to lymphocyte ratio, stroke territory, and 3-month mortality in patients with acute ischemic stroke. Neurol Sci 40, 139–146 (2019). https://doi.org/10.1007/s10072-018-3604-y

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  • DOI: https://doi.org/10.1007/s10072-018-3604-y

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