A High Neutrophil-to-Lymphocyte Ratio Predicts Higher Risk of Poststroke Cognitive Impairment: Development and Validation of a Clinical Prediction Model.

Fei Zha,Cheng Chen,Xiaoqi Ji,Yinyin Wu,Jingjing Zhao,Meng Li,Li Yao

doi:10.3389/fneur.2021.755011

Abstract

ObjectivePoststroke cognitive impairment (PSCI) is a serious complication of stroke. The neutrophil-to-lymphocyte ratio (NLR) is a marker of peripheral inflammation. The relationship between the NLR and PSCI is far from well studied, and the thesis of this study was to assess the predictive value of the NLR in patients with PSCI, and establish and verify the corresponding prediction model based on this relationship.MethodsA total of 367 stroke patients were included in this study. Neutrophils, lymphocytes, and NLRs were measured at baseline, and clinical and neuropsychological assessments were conducted 3 months after stroke. The National Institutes of Health Scale (NIHSS) was used to assess the severity of stroke. A Chinese version of the Mini Mental State Examination (MMSE) was used for the assessment of cognitive function.ResultsAfter three months of follow-up, 87 (23.7%) patients were diagnosed with PSCI. The NLR was significantly higher in PSCI patients than in non-PSCI patients (P < 0.001). Patient age, sex, body mass index, NIHSS scores, and high-density lipoprotein levels also differed in the univariate analysis. In the logistic regression analysis, the NLR was an independent risk factor associated with the patients with PSCI after adjustment for potential confounders (OR = 1.67, 95%CI: 1.21–2.29, P = 0.002). The nomogram based on patient sex, age, NIHSS score, and NLR had good predictive power with an AUC of 0.807. In the validation group, the AUC was 0.816.ConclusionAn increased NLR at admission is associated with PSCI, and the model built with NLR as one of the predictors can increase prognostic information for the early detection of PSCI.

Highlights

Stroke is the second most important cause of declining acquired cognitive ability and dementia worldwide, with a high rate of disability [1–3]
The criteria for selecting the subjects were as follows: [1] patients aged between 18 and 80 years; [2] patients with diagnoses confirmed by computerized tomography (CT) or magnetic resonance imaging (MRI) at the time of admission; [3] patients with complete information including neutrophil and lymphocyte levels; and [4] patients who completed the Chinese version of the Mini Mental State Examination (MMSE) assessment at the 3 month follow-up at hospital discharge
At the 3 month follow-up, 87 out of the 367 patients were diagnosed with poststroke cognitive impairment (PSCI) (23.7%)

Summary

Introduction

Stroke is the second most important cause of declining acquired cognitive ability and dementia worldwide, with a high rate of disability [1–3]. The incidence of poststroke cognitive impairment (PSCI) varies from 17–92% per year [4–6]. The recognition and early diagnosis of PSCI are of great significance for the functional recovery of stroke patients. The existing body of research on PSCI has been reported, including white matter changes, brain microbleeds, silent infarcts, and lacunes [7–9]. Age, years of education, and National Institutes of Health Scale (NIHSS) scores were reported [10–13]. Neurodegenerative and vascular mechanisms can cause significant increases in inflammatory markers, including C-reactive protein, IL-1, IL-18, IL-6, and TNF-α, which may be the reason for PSCI [14, 15]. Extensive studies have shown that inflammatory pathophysiology plays a crucial role in regulating cognitive impairment [16–18]. As an inflammatory marker, studies on the effects of the neutrophil-tolymphocyte ratio (NLR) on PSCI are limited [19]

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Conclusion