Correlation Between Neutrophil To Lymphocyte Ratio And The Acute Cerebral Infarction

ObjectiveThe neutrophil to lymphocyte ratio(NLR)as a new inflammatory marker.The predictive value on prognosis in patients with coronary heart disease,acute coronary syndromes has been confirmed.The value on patients with acute cerebral infarction has been concerned.So this study aims to investigate the correlation between the neutrophil to lymphocyte ratios(NLR)on admission and the the severity the early neurological deterioration and the outcome in patients with acute cerebral infarction.Continue to analysis the NLR with risk factors of acute cerebral infarction.MethodsA cohort study was performed in the clinical data of 344 patients with acute cerebral infarction who were admitted to the department of Neurology,the Fifth Affiliated Hospital of Zhengzhou University from January 2014 to December 2015,including 91 females and 235 males.The age,gender,past medical history,the National Institutes of Health Stroke Scale(NIHSS)were documented on admission.The NLR was calculated according to the neutrophil and lymphocyte counts on admission.They were divided into ether a mild cerebral infarction group(n=204)or a moderate-severe cerebral infarction group(n=140)according to the NIHSS score on admission;They were divided into ether a early neurological deterioration group(n=56)or a non-early neurological deterioration group(n=288)according to change of the NIHSS score in the first 72 h after stroke onset;they were divided into ether a good prognosis group(n=195)or a poor prognosis group(n=112)according to the scoring criteria of the modified Rankin Scale(mRS).The influence of variable on the severity on admission,the early neurological deterioration and the outcome of stroke was analyzed by Logistics regression analysis.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of NLR level on admission with the acute cerebral infarction on admission.Results(1)The level of NLR was higher in patients with acute cerebral infarction who also were with hypertension,atrial fibrillation and recurrent cerebral infarction(all P <0.05).(2)Compared with the mild cerebral infarction group,the level of NLR was significantly higher in the moderate-severe cerebral infarction group([2.87(2.21,5.29)vs 2.64(1.94,3.68),P <0.05)].After adjustment for age,the history of coronary heart disease,the NLR level is associated with the severity of cerebral infarction(OR:1.100,95%CI:1.015~1.192).(3)Compared with non-early neurological deterioration group,the level of NLR was significantly higher in the early neurological deterioration group [(3.02(2.33,4.95)vs 2.70(1.97,4.06),P<0.05)].After adjustment for the NIHSS score,age,history of coronary heart disease,the NLR level was not an independent predictor for early neurological deterioration(OR:1.065,95%CI:0.980~1.159).(4)Compared with the good prognosis group,the level of NLR was higher in the patients with poor prognosis [3.66(2.62,7.91)vs 2.47(1.94,3.40),P <0.05)].After adjustment for the age,NIHSS score on admission,the incidence of recurrent cerebral infarction,NLR level was an independent predictor for poor prognosis(OR: 1.427,95% CI: 1.247 ~ 1.634).(5)The ROC curve analysis showed that the NLR level was valuable for the poor prognosis in patients with acute cerebral infarction,the diagnostic cut-off was 2.84.Its sensitivity was 69.6% and specificity was 64.6%,the area under the curve was 0.711,and the NLR had a greater power in the prediction than White blood cell count(WBC),N and L(the area under the curve was:0.600,0.661,0.320).Conclusion(1)The level NLR in patients with hypertension,atrial fibrillation and recurrent cerebral infarction was significantly higher,this suggests that the risk factors in patients with acute cerebral infarction may have a higher inflammation status.(2)the level of NLR on admission can reflect the severe severity of acute cerebral infarction,the higher NLR level on admission,the more severe the patient's condition.(3)The NLR level on admission can reflect the prognosis of acute cerebral infarction.The higher the NLR level on admission,the greater risk of poor prognosis.the NLR had a greater power in the prediction than White blood cell count(WBC),N and L.