Neutrophil-to-Lymphocyte Ratio Predicts Severe Ischemic Stroke-Associated Pneumonia

Objective: This research mainly discusses the predictive value of ratio for neutrophil to lymphocyte(NLR)in the stroke-associated pneumonia(SAP)of patients with severe ischemic stroke.Methods: This was a restrospective study of 120 patient with severe stroke-associated(NIHSS Score ?9)who were treated in the second affiliated Hospital of Dalian Medical University NICU from September 2017 to September 2019,All of them were compliance with research standards.(1)Based on the occurrence of SAP,these patients were divided into SAP group and non-SAP group,recored the time of SAP occurrence.(2)General data of patients were recorded,including baseline data(age,sex,history of smoking,history of drinking,hypertension,diabetes,coronary heart disease,hyperlipidemia,atrial fibrillation,history of stroke),clinical data(time of visit,NIHSS score,GCS score,A2DS2 score,intravenous thrombolysis theapy,etiological classification of TOAST,infarction area,infartion volume,days in hospital,dysphagia),imaging data(imaging CT and MRI of brain),Physical and chemical indexes of first test after onset of disease(white blood count,neutrophil,lymphocyte,platelet,CRP,calculate NLR),Single factor analysis was used to compare the difference of appeal indexes between SAP group and non-SAP group.(3)Single factor analysis and multivariate Logistic regression analysis were used to find out the independent risk factors of SAP.(4)ROC curve was drawn to evaluate the predictive the value of NLR for SAP.Results: 1.120 patients with severe ischemic stroke who met the research were included in this study,there were 36 cases(30%)in SAP group with an average age of65.34 ± 12.85 years old and male 21 cause(58.33%),there were 84 cases(70%)innon-SAP group with an average age of 61.78 ± 6.13 years old and male 48 cause(57.14%),The median time for occurrence of SAP was 3(2-5)days after stroke;2.The age,atrial fibrillation,intravenous thrombolysis theapy,etiological classification of TOAST,infarction area,days in hospital,dysphagia,infarction volume,white blood count,neutrophil,lymphocyte,NLR at admission,A2DS2 and NIHSS score of the two groups were compared,and the differences were statistically significant(P<0.05).There were no significant differences in sex,history of smoking,history of drinking,hypertension,diabetes,coronary heart disease,hyperlipdemia,history of stroke,visit of time,platelets and CRP between the two groups(P>0.05);3.Multivariate Logistic regression analysis showed that infarction area,dysphagia,neutrophil,lymphocyte,NLR at admission and NIHSS score were independent risk factors for SAP(P<0.05);4.The area under the curve of NLR for predicting SAP was 0.75,the optimal cut-off value of NLR was 2.5,with a specificity of 65%,and a sensitivity of 92% for predicting SAP;Conclusion: Infarction area,dysphagia,neutrophil,lymphocyte,NLR at admission and NIHSS score were independent risk factors for SAP,and NLR can be used as a predictor of SAP in patients with severe ischemic stroke.