Study On The Predictive Value Of NLR And PLR For Progressive Ischemic Stroke

Objective:To explore the predictive value of peripheral blood neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)on the occurrence of progressive ischemic stroke(PIS).Method:The clinical data of patients with acute ischemic stroke who visited the Department of Neurology of Cangzhou people’s Hospital from September2019 to September 2020 were retrospectively analyzed.After inclusion and exclusion criteria,189 patients were finally enrolled.The patients were divided into progressive ischemic stroke(PIS)group and non progressive ischemic stroke(NPIS)group according to the progressive aggravation of neurological deficit symptoms within 6 hours to 7 days after onset,and the NIHSS score increased by more than 2 points when the condition changed.The general clinical data(age,gender,past history,etc.)and laboratory indexes(blood routine,biochemical indexes,etc.)of the two groups were collected.According to NLR = absolute value of neutrophils / lymphocytes,PLR =absolute value of platelet count / lymphocytes,NLR and PLR values were calculated and statistically analyzed between the two groups.Multivariate logistic regression was used to analyze the influencing factors of PIS in patients with acute ischemic stroke.Receiver operating characteristic curve(ROC)was used to evaluate the predictive effect of NLR,PLR and NLR +PLR on the occurrence of PIS.The best cut-off values of NLR and PLR were obtained by ROC calculation.According to the best cut-off values of NLR and PLR,the patients were divided into high NLR group and low NLR group,high PLR group and low PLR group,and compared whether there were differences in the risk of PIS between the groups.According to the NLR and PLR levels of the patients,they were divided into four groups according to the quartile method.The Jonckheere-Terpstra test method was used to test the trend between the incidence of PIS and NLR or PLR levels.Result:1 Compared with the NPIS group,the number of hypertension cases,white blood cell count,absolute value of neutrophils,NLR,PLR,fasting blood glucose,and fibrinogen in the PIS group were increased,and the absolute value of lymphocytes was reduced,and the difference was statistically significant(P <0.05).2 Multivariate logistic regression analysis showed that NLR was an independent risk factor for PIS(OR:0.912,95% CI:1.031-6.011,P = 0.043<0.05).3 Using ROC curve analysis and calculating the area under curve(AUC),the AUC of NLR to judge the occurrence of PIS was 0.775.When the best cut-off value was 3.440,the sensitivity was 59.2%,and the specificity was 87.3%.the AUC of PLR to judge the occurrence of PIS was 0.663.When the best cut-off value was 143.713,the sensitivity and specificity were 53.5%and the specificity was 78.0%.The AUC of NLR+PLR to judge the occurrence of PIS was 0.776,the sensitivity was 59.2%,and the specificity was 88.1%.4 According to the best cut-off value of NLR 3.44,the study population was divided into high NLR group and low NLR group,and the difference in the number of cases of PIS between the two groups was statistically significant(P <0.001).Compared with the low NLR group(NLR≤3.44),the risk of PIS in the high NLR group(NLR>3.44)was about 2.2 times that of the low NLR group(OR:2.223,95% CI:4.547-18.747,P <0.001).According to the best cut-off value of PLR 143.71,the study population was divided into high PLR group and low PLR group.There was a significant difference in the incidence of PIS between high PLR group and low PLR group(P <0.001).Compared with the low PLR group(PLR≤143.71),the risk of PIS in the high PLR group(PLR>143.71)was about 1.4 times that of the low PLR group(OR:1.405,95% CI: 2.153-7.712,P <0.001).5 According to the NLR and PLR levels,the patients were divided into four groups according to the quartile method,and the jonckheere-Terpstra test was used for trend test analysis.According to NLR,each subgroup(Q1-Q4)included 49,45,48 and 47 patients,and the proportion of PIS patients in each subgroup was 12.7%,9.9%,25.4% and 52.1%,respectively.The results showed that there were significant differences among the subgroups(P <0.001).According to PLR,each subgroup(Q5-Q8)included 47,48,47 and 47 patients,and the proportion of PIS patients in each subgroup was 19.7%,14.1%,28.2% and 38.0% respectively.The results showed that there were significant differences among the subgroups(P <0.001).Conclusion:In this study,a variety of methods were used to infer NLR and PLR comprehensively,which had good predictive value for the occurrence of PIS.It is found that NLR and PLR are closely related to the occurrence of PIS.High levels of NLR and PLR suggest that PIS is more likely to occur in clinic.Selecting NLR and PLR as important early warning markers is helpful to early identify the high-risk population of PIS in acute ischemic stroke,which is convenient for clinical intervention and treatment in time.