Relationship Between Neutrophil/Lymphocyte Ratio And Progressive Ischaemic Stroke

Objective:To investigate the predictive value of peripheral blood neutrophil to lymphocyte ratio(NLR)for the development of progressive ischemic stroke(PIS).Methods:The clinical data of acute ischemic stroke patients who visited our neurology department from August 2021 to December 2022 were selected for analysis.Patients were classified into progressive ischemic stroke(PIS)and non,progressive ischemic stroke(PIS)groups based on whether they experienced progressive exacerbation of neurological deficits within 6 hours to 7 days of onset and when their condition changed according to the National Institute of Health Stroke Scale(NIHSS).The patients were divided into a progressive ischemic stroke(PIS)group and a non,progressive ischemic stroke(NPIS)group based on an increase of 2 or more points in the overall NIHSS score compared with the overall score at the time of admission.General clinical data(age,gender,past history,personal history,etc.)and laboratory parameters including routine blood count,coagulation routine,creatinine,blood uric acid,high sensitive C,reactive protein,lipids,homocysteine,fasting glucose,etc.were collected from both groups,and the NLR values were calculated based on NLR=neutrophil count/lymphocyte count.Statistical analysis between the PIS group and NPIS group was performed.The factors influencing the occurrence of PIS in patients with acute ischemic stroke were analyzed by univariate and multifactorial logistic regression,and the predictive effect of NLR on the occurrence of PIS was evaluated by using the receiver operating characteristic curve(ROC).The best cut,off value of NLR for predicting the occurrence of PIS was calculated from the ROC curve,and the study population was divided into a high NLR group and a low NLR group according to the best cut,off value of NLR,and whether there was a difference in the risk of PIS between the two groups.Results:1.232 patients were finally enrolled after screening by inclusion and exclusion criteria,94(40.5%)in the PIS group and 138(59.5%)in the NPIS group.the differences in history of hypertension,smoking history,high sensitive C,reactive protein,admission systolic blood pressure,neutrophil count,lymphocyte count,and NLR were statistically significant in the PIS group compared with the NPIS group(P < 0.05).2.Univariate logistic regression analysis showed that history of hypertension,history of smoking,high systolic blood pressure on admission,increased neutrophil count,decreased lymphocyte count,and increased NLR were influential factors for PIS(P < 0.05).3.Multifactorial logistic regression analysis showed that increased NLR,smoking history,and high systolic blood pressure on admission were independent risk factors for PIS with ORs of 1.219 [95% CI(1.083,1.372),P = 0.001],2.108 [95% CI(1.173,3.790),P = 0.013],and 1.018[ 95% CI(1.007,1.030),P = 0.002].4.Using ROC curve analysis and calculating the area under the curve(areaundercurve,AUC),NLR judged that the AUC for the occurrence of PIS was 0.653(P<0.001).5.The study population was divided into a low NLR group(NLR< 4.117)and a high NLR group(NLR ≥ 4.117)according to the optimal cut,off value of NLR of 4.117.The low NLR group included166 patients,and 52 patients showed progression,with an incidence of31.3%;the high NLR group included 66 patients,and 42 patients showed progression,with an incidence of The difference in the number of cases of PIS between the high NLR group and the low NLR group was statistically significant(P < 0.001).The risk of PIS in patients in the high NLR group was 3.837 times higher than that in the low NLR group,with an OR of 3.837 [95% CI: 2.107,6.985,P < 0.001].In addition,the differences in prothrombin time,high sensitive C,reactive protein,neutrophil count,and lymphocyte count between the high NLR group and the low NLR group were statistically significant(P < 0.05).Conclusion:1.Increased NLR,history of smoking,high systolic blood pressure on admission are independent risk factors for progression of acute cerebral infarction.2.NLR can be used as a predictor of PIS,and when NLR > 4.12,it predicts that the risk of PIS may be higher.