Antje Giede-Jeppe1, Dominik Madžar2, Jochen A Sembill2, Maximilian I Sprügel2, Selim Atay2, Philip Hoelter3, Hannes Lücking3, Hagen B Huttner2, Tobias Bobinger2. 1. Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen (FAU), Schwabachanlage 6, 91054, Erlangen, Germany. Antje.Giede-Jeppe@uk-erlangen.de. 2. Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen (FAU), Schwabachanlage 6, 91054, Erlangen, Germany. 3. Department of Neuroradiology, Friedrich-Alexander-University Erlangen (FAU), Erlangen, Germany.
Abstract
BACKGROUND: Inflammatory response is the hallmark of secondary brain injury in stroke patients. Neutrophil-to-lymphocyte ratio (NLR) emerged as a marker for functional outcome in several diseases. OBJECTIVES: To investigate the association between NLR on admission and during hospital stay and functional outcome in acute ischemic stroke (AIS). METHODS: This observational study included all consecutive AIS patients admitted at a German stroke center covering 2011-2013. Patient characteristics and clinical data were retrieved from institutional databases. Multivariate analysis was conducted to investigate parameters associated with functional outcome. Receiver operating characteristic (ROC) analysis was performed to identify the best cutoff for NLR to discriminate between favorable and unfavorable functional outcome. To account for imbalances in baseline characteristics, propensity score matching was carried out to assess the influence of NLR on functional outcome. RESULTS: A total of 807 patients with AIS were included for analysis. Patients with worse functional outcome at 3 months were older and had worse clinical status on admission, higher rates of infectious complications, and an increased NLR. ROC analysis identified a NLR of 3.3 as best cutoff value to discriminate between favorable and unfavorable functional outcomes (area under the curve 0.693, p < 0.001, Youden's index = 0.318; p < 0.001; sensitivity 68.5%, specificity 63.9%). Propensity-matched analysis still demonstrated a higher rate of unfavorable functional outcome at 3 months in patients with NLR ≥ 3.3 [modified Rankin scale 3-6 at 3 months: NLR ≥ 3.3 51.5% vs. NLR < 3.3 36.4%; p = 0.002]. CONCLUSIONS: In AIS patients we identified NLR as an important predictor for unfavorable functional outcome.
BACKGROUND: Inflammatory response is the hallmark of secondary brain injury in strokepatients. Neutrophil-to-lymphocyte ratio (NLR) emerged as a marker for functional outcome in several diseases. OBJECTIVES: To investigate the association between NLR on admission and during hospital stay and functional outcome in acute ischemic stroke (AIS). METHODS: This observational study included all consecutive AISpatients admitted at a German stroke center covering 2011-2013. Patient characteristics and clinical data were retrieved from institutional databases. Multivariate analysis was conducted to investigate parameters associated with functional outcome. Receiver operating characteristic (ROC) analysis was performed to identify the best cutoff for NLR to discriminate between favorable and unfavorable functional outcome. To account for imbalances in baseline characteristics, propensity score matching was carried out to assess the influence of NLR on functional outcome. RESULTS: A total of 807 patients with AIS were included for analysis. Patients with worse functional outcome at 3 months were older and had worse clinical status on admission, higher rates of infectious complications, and an increased NLR. ROC analysis identified a NLR of 3.3 as best cutoff value to discriminate between favorable and unfavorable functional outcomes (area under the curve 0.693, p < 0.001, Youden's index = 0.318; p < 0.001; sensitivity 68.5%, specificity 63.9%). Propensity-matched analysis still demonstrated a higher rate of unfavorable functional outcome at 3 months in patients with NLR ≥ 3.3 [modified Rankin scale 3-6 at 3 months: NLR ≥ 3.3 51.5% vs. NLR < 3.3 36.4%; p = 0.002]. CONCLUSIONS: In AISpatients we identified NLR as an important predictor for unfavorable functional outcome.
Authors: Jan Larmann; Jessica Handke; Anna S Scholz; Sarah Dehne; Christoph Arens; Hans-Jörg Gillmann; Florian Uhle; Johann Motsch; Markus A Weigand; Henrike Janssen Journal: BMC Cardiovasc Disord Date: 2020-05-18 Impact factor: 2.298
Authors: J R Grainger; C B Lawrence; S Krishnan; C O'Boyle; C J Smith; S Hulme; S M Allan Journal: Clin Exp Immunol Date: 2020-12-09 Impact factor: 5.732