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Prognostic role of Neutrophil to lymphocyte ratio(NLR),neutrophils and lymphocytes in patients with acute ischemic strokeObjectives: To investigated the association between neutrophil to lymphocyte ratio(NLR),neutrophils and lymphocytes count and stroke severity at admission,clinical outcomes(disablity at discharge,pneumonia after stroke and all-cause mortality at 90 days)in patients with actue ischemic stroke(AIS).Methods: Data of 803 AIS patients enrolled from April 2012 to January 2016 in zhangjiagang traditional Chinese medicine hospital were enrolled for the present studies.Demographic characteristics(age and gender),medical history,clinical features,laboratory variables,including neutrophils,lymphocytes count and NLR,image data(CT or MRI)were recorded.Clinical outcome in patients include stroke severity at admission,pneumonia after stroke,poor prognosis at discharge and all-cause mortality at 90 days after stoke.The stroke severity at admission of the patients was assessed by the National Institutes of Health Stroke Scale(NIHSS)score at admission.The disablity at discharge was defined as modified Rankin scale(m RS)score >2,and pneumonia after stroke was defined as consensus of diagnosis of srtoke-associated pneumonia in 2015.Patients were divided into 4 groups according to their levels of admission neutrophils,lymphocytes and NLR.A Spearman correlation analysis and multiple linear regression analyses were used to assess the correlation between NLR,neutrophils and lymphocytes with NIHSS score.Crude and multivariable logistic regression models were used for assessment the relationship between NLR,neutrophils and lymphocytes and disablity at discharge,pneumonia after stroke and all-cause mortality at 90 days.The predictive ability of NLR,neutrophils and lymphocytes on disablity at discharge,pneumonia after stroke and all-cause mortality was compared by calculating C-statistics(areas under receiver operating characteristic [ROC] curves)Results:1.In comparison with participants with lower NLR,those with higher NLR were more likely to be older,tend to be male,had more severe stroke(higher NIHSS)and other comorbidities including atrial fiblirration,smoking and drinking.Patients with higher NLR also differed in metabolic profle(higher white blood cell count,neutrophils count,fasting blood-glucose but lower lymphocytes count)and higher heart rate,systolic pressure and diastolic pressure at admission.2.The spearman correlation analysis showed that the admission NLR and neutrophils count positively correlated with the baseline NIHSS score(r=0.362 P<0.001;r=0.346 P<0.001),but lymphocytes count negatively correlated with the baseline NIHSS score(r=-0.163 P<0.001).After the adjustment of other risk factors,multivariable linear regression analysis showed the patients in the fourth NLR and neutrophils count quartile had higher NIHSS score(all P<0.001),however the patients in the fourth lymphocytes count quartile had lower NIHSS score(P<0.001).3.There were 265 patients(33.0%)with disability at hospital discharge.Compared with the patients in the first quartile,after adjusting for potential covariates including age,gender and NIHSS score,patients in the fourth quartile of NLR(OR=2.16,95%CI 1.23-3.78,P-trend<0.001)was 2.16 fold increased in the odds of disability at discharge and in the fourth quartile of neutrophils(OR=2.33,95%CI1.32-4.10,P-trend=0.007)was 2.33 fold increased.However,compared to the patients in the first quartile,the patients in the fourth quartile of lymphocytes(OR=0.47,95%CI 0.27-0.82,P-trend=0.012)was significantly decreased in the odds of disability at discharge.The ROC curve showed that the admission neutrophils(AUC=0.643,P<0.001),lymphocytes(AUC=0.377,P<0.001)and NLR(AUC=0.672,P<0.001)were associated to disablity at discharge and NLR plays the most important role in predicting disability at hospital discharge.4.There were 121 patients(15.1%)with pneumonia after stroke.Compared with the patients in the first quartile,after adjusting for potential covariates including age,gender and NIHSS score,patients in the fourth quartile of NLR(OR=3.88 95%CI 1.93-7.83,P-trend<0.001)was 3.88 fold increased in the odds of pneumonia after stroke and in the fourth quartile of neutrophils(OR=6.30 95%CI 2.97-13.35 P-trend<0.001)was 6.30 fold increased.However,compared with patients in the first quartile,patients in the fourth quartile of lymphocytes(OR=0.42,95%CI 0.21-0.86,P-trend =0.064)was significant associated with decreased in the odds of pneumonia after stroke.The ROC curve showed that the admission neutrophils(AUC=0.717,P<0.001),lymphocytes(AUC=0.353,P<0.001)and NLR(AUC=0.735,P<0.001)were associated to pneumonia after stroke and NLR plays the most important role in predicting pneumonia after stroke.5.There were 109 patients(13.6%)with all-cause mortality at 90 days after stroke.Compared with patients in the first quartile,after adjusting for potential covariates including age,gender and NIHSS score,patients in the fourth quartile of NLR(OR=8.03,95%CI 3.06-21.07,P-trend<0.001)was 8.03 fold increased in the odds of mortality at 90 days after stroke and in the fourth quartile of neutrophils(OR=5.01,95%CI 2.08-12.04,P-trend<0.001)was 5.01 fold increased.However compared with patients in the first quartile,patients in the fourth quartile of lymphocytes(OR=0.22,95%CI 0.09-0.53,P-trend<0.001)was significantly decreased in the odds of mortality at 90 days after stroke.The ROC curve showed that the admission neutrophils(AUC=0.732,P<0.001),lymphocytes(AUC=0.290,P<0.001)and NLR(AUC=0.775,P<0.001)were associated to mortality at 90 days after stroke and NLR plays the most important role in predicting mortality at 90 days after stroke.Conclusion:1.There were associated between NLR,neutrophils count,lymphocytes count at admission and stroke severity in patients with acute ischemic stroke.2.The higher NLR and neutrophils and the lower lymphocytes at admission were associated with increased risk of disability at discharge,pneumonia after stroke and all-cause mortality at 90 days after stoke.3.NLR plays the more important role in predicting disability at discharge,pneumonia after stroke and all-cause mortality at 90 days after stroke than neutrophils and lymphocytes.Part ? Prognostic role of Monocyte to HDL cholesterol ratio(MHR),monocyte and HDL in patients with acute ischemic stroke.Objectives: To investigated the association between monocyte to high density lipoprotein(HDL)cholesterol ratio(MHR),monocyte count and HDL cholesterol and stroke severity at admission,clinical outcomes(disablity at discharge,pneumonia after stroke and all-cause mortality at 90 days)in patients with actue ischemic stroke(AIS).Methods: Data of 803 AIS patients enrolled from April 2012 to January 2016 in zhangjiagang traditional Chinese medicine hospital were enrolled for the present studies.Demographic characteristics(age and gender),medical history,clinical features,laboratory variables,including monocyte count,HDL cholesterol level and MHR,image data(CT or MRI)were recorded.Clinical outcome in patients include stroke severity at admission,pneumonia after stroke,poor prognosis at discharge and all-cause mortality at 90 days after stoke.The stroke severity at admission of the patients was assessed by the National Institutes of Health Stroke Scale(NIHSS)score at admission.The disablity at discharge was defined as modified Rankin scale(m RS)score >2,and pneumonia after stroke was defined as consensus of diagnosis of srtoke-associated pneumonia in 2015.Patients were divided into 4 groups according to their levels of admission monocyte,HDL cholesterol and MHR.A Spearman correlation analysis and multiple linear regression analyses were used to assess the correlation between MHR,monocyte count and HDL cholesterol with NIHSS score.Crude and multivariable logistic regression models were used for assessment the relationship between MHR,monocyte count and HDL cholesterol and disablity at discharge,pneumonia after stroke and all-cause mortality at 90 days.The predictive ability of MHR,monocyte count and HDL cholesterol on pneumonia after stroke was compared by calculating C-statistics(areas under receiver operating characteristic [ROC] curves).Results:1.In comparison with participants with lower MHR,those with higher MHR were more likely to tend to be male and other comorbidities including hypertension,smoking and drinking.Patients with higher MHR also differed in metabolic profle(higher white blood cell count,neutrophils count,monocyte count but lower total cholesterol,low density lipoprotein(LDL)cholesterol and HDL cholesterol level.2.The spearman correlation analysis showed that the monocyte count and HDL cholesterol level positively correlated with the baseline NIHSS score(r=0.131 P<0.001;r=0.094 P=0.008),however MHR was no correlated with the baseline NIHSS score.After adjusted age,sex,time from onset to admission and other potential risk factors,multivariable linear regression analysis showed patients in the fourth HDL cholesterol quartile had higher NIHSS score(P=0.001).3.There were 265 patients(33.0%)with disability at hospital discharge.Whether multiple factors are adjusted or not,there was no associated between the admission MHR,monocyte count and HDL cholesterol level and poor prognosis at discharge.4.There were 121 patients(15.1%)with pneumonia after stroke.Compared with patients in the first quartile,and after adjustment for multivariate,patients in the fourth quartile of MHR(OR=2.79,95%CI 1.44-5.42,P-trend=0.003)was 2.79 fold increased in the odds of pneumonia after stroke and in the fourth quartile of monocyte(OR=2.60,95%CI 1.28-5.30,P-trend=0.005)was 2.60 fold increased.However whether multiple factors are adjusted or not,there was no associated between HDL cholesterol level and pneumonia after stroke.The ROC curve showed that admission MHR(AUC=0.572,95%CI 0.514-0.630,P=0.011)and monocyte count(AUC=0.606,95%CI 0.551-0.662 P<0.001)were associated to pneumonia after stroke and monocyte plays the more important role in predicting pneumonia after stroke than MHR.5.There were 109 patients(13.6%)with all-cause mortality at 90 days after stroke.Compared with patients in the first quartile,patients in the fourth quartile of HDL cholesterol level had higher all-cause mortality at 90 days after stroke.However after adjustment for multivariate,there was no associated between the admission HDL cholesterol level and all-cause mortality at 90 days after stroke.Whether multiple factors are adjusted or not,there was no associated between the admission MHR,monocyte count and all-cause mortality at 90 days after stroke.Conclusion:1?The admission HDL cholesterol level was correlated with stroke severity,however the admission MHR and monocyte count were no correlated with stroke severity.2?There were no associated between MHR,monocyte count and HDL cholesterol level at admission and poor prognosis at discharge and all-cause mortality at 90 days after stroke in patients with acute ischemic stroke.3?The higher MHR and monocyte count at admission were associated with pneumonia after stroke and the ability of monocyte in predicting pneumonia after stroke was better than MHR. |
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