Role of Platelet to Lymphocyte Ratio, Neutrophil to Lymphocyte Ratio and Lymphocyte to Monocyte Ratio in Acute Ischaemic Stroke Severity: A Prospective Cohort Study

Abstract

Introduction: Stroke is one of the leading causes of mortality and morbidity worldwide, with ischaemic stroke being the most common . Inflammation plays a key role in the pathogenesis of ischaemic stroke and the tissue injury that occurs poststroke, leading to stroke severity. Aim: To assess whether the Neutrophil to Lymphocyte Ratio (NLR), Lymphocyte to Monocyte Ratio (LMR), and Platelet to Lymphocyte Ratio (PLR) ratios correlate with the severity of ischaemic stroke in acute ischaemic stroke cases. Materials and Methods: This was a prospective cohort study conducted at KR Hospital, Mysore, Karnataka, India from July 2021 to June 2022, wherein 106 ischaemic stroke cases presenting within 24 hours of symptom onset were assessed, and the outcomes at discharge or at the end of one week were noted. Routine investigations and Non Contrast Computed Tomography (NCCT) brain scans were performed at the time of admission. National Institute of Health Stroke Scale (NIHSS) scoring was conducted at admission, and patients were grouped into mild to moderate stroke (<16) and severe stroke (≥16) categories. The values of PLR, NLR, and LMR were calculated from the blood routine performed at admission. The data was entered into Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) 25.0 software. A p-value of <0.05 was considered statistically significant. Results: The mean age in this study was 62.67±14.225 years, of which the majority 76 (71.7%) were males. Co-morbidities included hypertension 53 (50%), diabetes 26 (24%), previous history of stroke 13 (12.3%), chronic alcohol consumption 44 (41.5%), and smoking 47 (44.3%) within the study population, and no significant association was found with stroke severity. Approximately 17% presented with severe stroke, while 83% presented with mild to moderate stroke. The total count in the mild to moderate stroke (<16) group was 10.5345±3.91 103 /mm3 and in the severe stroke group (≥16), it was 15.445±10.27 103 /mm3 . In the mild to moderate stroke group (<16), the mean NLR, PLR, and LMR were 5.93±5.16, 179.79±120.72, and 6.14±6.98, respectively. In the severe stroke group (≥16), the mean NLR, PLR, and LMR were 13.83±24.62, 175.1±89.20, and 3.96±3.89, respectively. Conclusion: The PLR, NLR, and LMR ratios can be used to assess the severity of stroke cases, especially in resourcelimited settings.

Keywords

• cerebrovascular accident
• inflammation
• leucocytes
• mortality
• neurologic deficit
• platelet count
• white blood cell count