Role of Neutrophil and Lymphocyte Ratio to Predict the Prognosis of Acute Ischemic Stroke

Abstract

Objective: To determine the predictive value of the Neutrophil-to-Lymphocyte Ratio (NLR) in assessing the prognosis of acute ischemic stroke (AIS).

Methodology: This prospective cross-sectional study was done at neurosurgery department of Isra University Hospital Hyderabad from March 2021 to February 2022. Patients aged 18 years or old, both gender and were presented at the neurology department with stroke ((basis on clinical features and confirmed CT or MRI) within 24 hours of symptom onset were included. A 5ml blood sample was obtained each patient for CBC. NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte counts. The National Institutes of Health Stroke Scale (NIHSS) score was assessed upon admission and at the time of discharge.

Results: Mean age of the patients was 59.85+13.89 years. Females were in majority 52.9% and males were 47.1%. The overall mean NLR is 10.80, and the differences across stroke severity are statistically significant (p = 0.049). Regression analysis indicated that the NLR is a significant predictor of AIS severity at both admission and discharge. At admission, NLR explains 9.5% of the variance in NIHSS scores (R² = 0.095) with an F-value of 6.536 and a p-value of 0.013, showing statistical significance. Each unit increase in NLR is associated with a 0.268 increase in NIHSS score. At discharge, NLR explains 23.8% of the variance in NIHSS scores (R² = 0.238), with each unit increase in NLR corresponding to a 0.826 increase in NIHSS score (p = 0.000), indicating a stronger relationship between NLR and stroke severity.

Conclusion: The NLR has been identified as a strong predictor of acute ischemic stroke severity, accounting for a significant portion of the variance in NIHSS scores at admission. Given its ease of measurement and its significant association with stroke severity, further large-scale studies are recommended to explore the underlying mechanisms of this relationship.