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Increased Neutrophil-to-Lymphocyte Ratio is Associated with Unfavorable Functional Outcome in Acute Ischemic Stroke

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Abstract

Background

Inflammatory response is the hallmark of secondary brain injury in stroke patients. Neutrophil-to-lymphocyte ratio (NLR) emerged as a marker for functional outcome in several diseases.

Objectives

To investigate the association between NLR on admission and during hospital stay and functional outcome in acute ischemic stroke (AIS).

Methods

This observational study included all consecutive AIS patients admitted at a German stroke center covering 2011–2013. Patient characteristics and clinical data were retrieved from institutional databases. Multivariate analysis was conducted to investigate parameters associated with functional outcome. Receiver operating characteristic (ROC) analysis was performed to identify the best cutoff for NLR to discriminate between favorable and unfavorable functional outcome. To account for imbalances in baseline characteristics, propensity score matching was carried out to assess the influence of NLR on functional outcome.

Results

A total of 807 patients with AIS were included for analysis. Patients with worse functional outcome at 3 months were older and had worse clinical status on admission, higher rates of infectious complications, and an increased NLR. ROC analysis identified a NLR of 3.3 as best cutoff value to discriminate between favorable and unfavorable functional outcomes (area under the curve 0.693, p < 0.001, Youden’s index = 0.318; p < 0.001; sensitivity 68.5%, specificity 63.9%). Propensity-matched analysis still demonstrated a higher rate of unfavorable functional outcome at 3 months in patients with NLR ≥ 3.3 [modified Rankin scale 3–6 at 3 months: NLR ≥ 3.3 51.5% vs. NLR < 3.3 36.4%; p = 0.002].

Conclusions

In AIS patients we identified NLR as an important predictor for unfavorable functional outcome.

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Acknowledgements

We thank Dr. Petra Burkardt (Friedrich-Alexander-University Erlangen (FAU), Erlangen, Germany) for helping with data acquisition.

Funding

None.

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Authors and Affiliations

  1. Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen (FAU), Schwabachanlage 6, 91054, Erlangen, Germany

    Antje Giede-Jeppe, Dominik Madžar, Jochen A. Sembill, Maximilian I. Sprügel, Selim Atay, Hagen B. Huttner & Tobias Bobinger

  2. Department of Neuroradiology, Friedrich-Alexander-University Erlangen (FAU), Erlangen, Germany

    Philip Hoelter & Hannes Lücking

Authors
  1. Antje Giede-Jeppe
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  2. Dominik Madžar
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  3. Jochen A. Sembill
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  4. Maximilian I. Sprügel
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  5. Selim Atay
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  6. Philip Hoelter
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  7. Hannes Lücking
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  8. Hagen B. Huttner
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  9. Tobias Bobinger
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Contributions

AGJ, HBH and TB were involved in the study concept, data acquisition, analysis and interpretation of data, writing the manuscript. DM, JAS and MIS were involved in the analysis and interpretation of data, critical revision of manuscript. PH, HL were involved in the data acquisition, interpretation of data, critical revision of manuscript.

Corresponding author

Correspondence to Antje Giede-Jeppe.

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The authors declare that they have no conflict of interest.

Ethical approval/Informed consent

All consecutive patients with the diagnosis of AIS admitted to a German tertiary stroke center (Department of Neurology, University Hospital Erlangen, Germany) were included in a prospective longitudinal institutional database, which was approved by the institutional ethics committee.

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Giede-Jeppe, A., Madžar, D., Sembill, J.A. et al. Increased Neutrophil-to-Lymphocyte Ratio is Associated with Unfavorable Functional Outcome in Acute Ischemic Stroke. Neurocrit Care 33, 97–104 (2020). https://doi.org/10.1007/s12028-019-00859-5

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  • DOI: https://doi.org/10.1007/s12028-019-00859-5

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