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. 2021 Jul 29:12:705949.
doi: 10.3389/fneur.2021.705949. eCollection 2021.

Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Stroke Severity and Short-Term Prognosis in Acute Ischemic Stroke With Intracranial Atherosclerotic Stenosis

Yuanlin Ying  1 , Fang Yu  1 , Yunfang Luo  1 , Xianjing Feng  1 , Di Liao  1 , Minping Wei  1 , Xi Li  1 , Qin Huang  1 , Zeyu Liu  1 , Lin Zhang  1 , Tingting Zhao  1 , Ruxin Tu  1 , Jian Xia  1   2   3
Affiliations

Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Stroke Severity and Short-Term Prognosis in Acute Ischemic Stroke With Intracranial Atherosclerotic Stenosis

Yuanlin Ying et al. Front Neurol. .

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) is an indicator of poor prognosis in acute ischemic stroke (AIS), but associations between NLR with stroke severity and prognosis of intracranial atherosclerotic stenosis (ICAS)-related ischemic events have not been well-elucidated; therefore, we aimed to evaluate whether admission NLR levels correlate with the early stroke severity and short-term functional prognosis in patients with symptomatic intracranial atherosclerotic stenosis (sICAS). Methods: This retrospective study enrolled 899 consecutive patients with AIS attributed to ICAS at Xiangya Hospital stroke center between May 2016 and September 2020. The initial stroke severity was rated by the admission National Institutes of Health Stroke Scale (NIHSS) scores, and the short-term prognosis was evaluated using the 14-day modified Rankin Scale (mRS) scores after stroke onset. A severe stroke was defined as NIHSS >8; an unfavorable functional outcome was defined as mRS scores of 3-6. Admission NLR was determined based on circulating neutrophil and lymphocyte counts. Results: The median admission NLR of all patients was 2.80 [interquartile range (IQR), 2.00-4.00]. In univariate analysis, admission NLR was significantly elevated in patients with severe stroke and poor short-term prognosis. After multivariate adjustment, admission NLR levels were significantly correlated with severe stroke [odds ratio (OR), 1.132; 95% confidence interval (95% CI), 1.038-1.234; P = 0.005] and unfavorable short-term prognosis (OR, 1.102; 95% CI, 1.017-1.195; P = 0.018) in Model 1. In Model 2, the highest NLR tertile (≥3.533) remained an independent predictor of severe stroke (OR, 2.736; 95% CI, 1.590-4.708; P < 0.001) and unfavorable functional outcome (OR, 2.165; 95% CI, 1.416-3.311; P < 0.001) compared with the lowest NLR tertile (<2.231). The receiver operating characteristic (ROC) curves showed the predictability of NLR regarding the stroke severity [area under the curve (AUC), 0.659; 95% CI, 0.615-0.703; P < 0.001] and short-term prognosis (AUC, 0.613; 95% CI, 0.575-0.650; P < 0.001). The nomograms were constructed to create the predictive models of the severity and short-term outcome of sICAS. Conclusions: Elevated admission NLR levels were independently associated with the initial stroke severity and could be an early predictor of severity and poor short-term prognosis in AIS patients with ICAS, which might help us identify a target group timely for preventive therapies.

Keywords: intracranial atherosclerotic stenosis; ischemic stroke; neutrophil-to-lymphocyte ratio; short-term prognosis; stroke severity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Comparisons of admission NLR levels according to the severity and number of intracranial atherosclerotic stenosis in sICAS patients. (A) Comparison of admission NLR levels according to the severity of intracranial atherosclerotic stenosis. (B) Comparison of admission NLR levels according to the number of intracranial atherosclerotic stenosis. P < 0.05 was considered statistically significant. NLR, neutrophil-to-lymphocyte ratio; sICAS, symptomatic intracranial atherosclerotic stenosis.
Figure 2
Figure 2
Comparisons of admission NLR levels according to HT and CED in sICAS patients. (A) Comparison of admission NLR levels according to HT (without HT vs. with HT). (B) Comparison of admission NLR levels according to CED (none-mild CED vs. moderate-severe CED). P < 0.05 was considered statistically significant. NLR, neutrophil-to-lymphocyte ratio; sICAS, symptomatic intracranial atherosclerotic stenosis; HT, hemorrhagic transformation; CED, cerebral edema.
Figure 3
Figure 3
Comparisons of admission NLR levels according to the initial stroke severity and short-term prognosis of sICAS. (A) Comparison of admission NLR levels according to the initial stroke severity (severe stroke vs. mild controls). (B) Comparison of admission NLR levels according to the short-term prognosis (unfavorable outcome vs. favorable outcome). NLR, neutrophil-to-lymphocyte ratio; sICAS, symptomatic intracranial atherosclerotic stenosis.
Figure 4
Figure 4
ROC curves for the initial stroke severity and short-term prognosis of sICAS with NLR. (A) ROC curve for the initial stroke severity of sICAS with NLR (severe stroke vs. mild controls). (B) ROC curve for the short-term prognosis of sICAS with NLR (unfavorable outcome vs. favorable outcome). ROC, receiver operating characteristic; sICAS, symptomatic intracranial atherosclerotic stenosis; AUC, area under the curve; NLR, neutrophil-to-lymphocyte ratio; CI, confidence interval.
Figure 5
Figure 5
The nomogram for predicting the severity of sICAS patients. (A) The nomogram for predicting the risk of severe neurological deficit of sICAS patients. (B) The ROC curve of the nomogram. The predictors were chosen based on the results of multivariate logistic regression in Model 1. Each selected factor was shown by a line in the nomograms. sICAS, symptomatic intracranial atherosclerotic stenosis; CED, cerebral edema; WBC, white blood cell; NLR, neutrophil-to-lymphocyte ratio; ROC, receiver operating characteristic; AUC, area under the curve.
Figure 6
Figure 6
The nomogram for predicting the short-term prognosis of sICAS patients. (A) The nomogram for predicting the risk of unfavorable short-term outcome of sICAS patients. (B) The ROC curve of the nomogram. The predictors were chosen based on the results of multivariate logistic regression in Model 1. Each selected factor was shown by a line in the nomograms. sICAS, symptomatic intracranial atherosclerotic stenosis; NLR, neutrophil-to-lymphocyte ratio; UA, uric acid; CAD, coronary artery disease; ROC, receiver operating characteristic; AUC, area under the curve.
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References

    1. Virani S, Alonso A, Benjamin E, Bittencourt M, Callaway C, Carson A, et al. . Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. (2020) 141:e139–596. 10.1161/CIR.0000000000000757 - DOI - PubMed
    1. Ornello R, Degan D, Tiseo C, Di Carmine C, Perciballi L, Pistoia F, et al. . Distribution and temporal trends from 1993 to 2015 of ischemic stroke subtypes: a systematic review and meta-analysis. Stroke. (2018) 49:814–9. 10.1161/STROKEAHA.117.020031 - DOI - PubMed
    1. Wong L. Global burden of intracranial atherosclerosis. Int J Stroke Offic J Int Stroke Soc. (2006) 1:158–9. 10.1111/j.1747-4949.2006.00045.x - DOI - PubMed
    1. Wong K, Li H. Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis. Stroke. (2003) 34:2361–6. 10.1161/01.STR.0000089017.90037.7A - DOI - PubMed
    1. Dearborn J, Zhang Y, Qiao Y, Suri M, Liu L, Gottesman R, et al. . Intracranial atherosclerosis and dementia: the Atherosclerosis Risk in Communities (ARIC) Study. Neurology. (2017) 88:1556–63. 10.1212/WNL.0000000000003837 - DOI - PMC - PubMed

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