Eosinophil-to-monocyte ratio is a potential biomarker in the prediction of functional outcome among patients with acute ischemic stroke

Shuhong Yu,Qiang Zhang,Chunyuan Zhang,Yi Luo,Fangyue Zeng,Zhiliang Guo,Chenrong Huang,Hao Huang,Yu Fu,Tan Zhang

doi:10.1186/s12868-021-00610-x

Abstract

BackgroundIt has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear. We aimed to determine the relationship between EMR on admission and 3-month poor functional outcome in AIS patients.MethodsA total of 521 consecutive patients admitted to our hospital within 24 h after onset of AIS were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission.ResultsAs EMR decreased, the risk of poor outcome increased (p < 0.001). Logistic regression analysis revealed that EMR was independently associated with poor outcome after adjusting potential confounders (odds ratio, 0.09; 95% CI 0.03–0.34; p = 0.0003), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.23; 95% CI 0.10–0.52; ptrend < 0.0001). A non-linear relationship was detected between EMR and poor outcome, whose point was 0.28. Subgroup analyses further confirmed these associations. The addition of EMR to conventional risk factors improved the predictive power for poor outcome (net reclassification improvement: 2.61%, p = 0.382; integrated discrimination improvement: 2.41%, p < 0.001).ConclusionsEMR on admission was independently correlated with poor outcome in AIS patients, suggesting that EMR may be a potential prognostic biomarker for AIS.

Highlights

It has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear
Post-stroke low circulating eosinophil count was inversely associated with stroke severity and risk of mortality, and high peripheral blood monocyte level was associated with high risk of poor outcome after stroke [7, 8]
Like other study in different diseases [9], EMR is used to identify patients at high risk of poor outcome in stroke, and we found the lower EMR on admission was associated with higher risk of 3-month poor functional outcome in patients with AIS, and proved EMR was of certain value in predicting poor outcome in patients with AIS

Summary

Introduction

It has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear. Inflammatory and immunological responses play pivotal roles in the pathogenesis of acute ischemic stroke (AIS) which is still a main challenge to public health [1,2,3]. Recent studies have discovered that stroke triggers an acute decrease in circulating eosinophil counts and an increase in circulating monocytes [6]. Post-stroke low circulating eosinophil count was inversely associated with stroke severity and risk of mortality, and high peripheral blood monocyte level was associated with high risk of poor outcome after stroke [7, 8]. Given the deleterious effects of classical monocytes and the possible neuroprotective effect of eosinophils in stroke [5, 10,11,12], eosinophil-to-monocyte ratio (EMR), a novel biomarker reflecting the integrated application value of eosinophils and monocytes, is needed to identify patients at high risk of poor prognosis

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