The Predictive Effect of the Neutrophil-to-Lymphocyte Ratio (NLR) on the Mortality of Acute Ischemic Stroke and its Subtypes: a Retrospective Cross-Sectional Study

Abstract

Aim:In this study, we aimed to evaluate the association between the neutrophil-to-lymphocyte ratio (NLR) and short-term mortality in cases of acute ischemic stroke (AIS) and its subtypes in emergency departments (EDs).Materials and Methods: This retrospective cross-sectional investigation included 164 patients presenting to the ED with AIS. The demographic characteristics of the patients, hemogram test results at presentation, co-morbidities, AIS subtype, arrival time at the ED (time between symptoms initiation to ED presentation, in hours), National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) scores, and the length of hospital stay (LHS) were recorded on a data collection form. The clinical outcome was assessed by the NIHSS score on admission, mRS scores at discharge, and on the number of days of hospitalization. Blood samples were analyzed by optical laser light scatter analysis methods (Abbott, cell-dyn Ruby 3700, USA).Results: Among the study cohort, 134 patients were discharged with a status of cured or surviving, whereas 30 patients did not survive. NLR ratios were higher among the patients who later expired than among the patients who were discharged (p=0.011). Mortality was the highest among cases with an undetermined origin. The WBC and neutrophil count differed significantly among the stroke subtype classifications (p=0.009 and 0.008, respectively), although NLR did not vary significantly among the stroke subtypes (p=0.070). The median LHS was 5 (1–116) days and did not differ significantly among the subtype groups (p=0.877).Conclusion: Higher NLR is associated with an increased mortality rate in patients with AIS but is not a good predictor for AIS subtypes.

Keywords

• Neutrophil to lymphocyte ratio
• acute ischemic stroke
• mortality