High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia.

Hao-Ran Cheng,Jia-Ying Song,Yi-Nuo Zhang,Gui-Qian Huang,Yun-Bin Chen,Gang-Qiang Lin,Jin-Cai He,Zhen Wang

doi:10.3389/fneur.2020.575809

Abstract

Purpose: Stroke-associated pneumonia (SAP), a common complication in acute ischemic stroke (AIS) patients, is associated with poor prognosis after AIS. Inflammation plays an important role in the development of SAP. In this study, we aimed to explore the association between the monocyte-to-lymphocyte ratio (MLR) and SAP in AIS patients.Methods: We continuously enrolled 972 AIS patients. SAP was diagnosed by two trained neurologists and confirmed by radiography, meeting the modified Centers for Disease Control and Prevention criteria. MLR values were measured for all participants, and all patients were evenly classified into three tertiles according to the MLR levels. We used the values that Youden's index max points corresponded to represent the optimal cutoffs, which represented the balance in sensitivity and specificity.Results: 104 (10.7%) patients were diagnosed with SAP. SAP patients showed a significant increased (P < 0.001) MLR when compared with non-SAP. The optimal cutoff points of MLR were (T1) <0.2513, (T2) 0.2513–0.3843, and (T3) > 0.3843. The incidence of SAP was significantly higher in the third MLR tertile than the first and second MLR tertiles (21.7 vs. 4 vs. 6.5%, respectively, P < 0.001). After adjusting for confounding and risk factors, multivariate regression analysis showed that the third MLR tertile was an independent variable predicting the occurrence of SAP (odds ratio = 3.503, 95%CI = 1.066–11.515, P = 0.039).Conclusions: Our study showed that higher MLR was significantly associated with SAP in AIS patients. MLR is beneficial for clinicians to recognize patients with a high risk of SAP at an early stage and is an effective way to improve clinical care of SAP patients. Higher MLR could be a helpful and valid biomarker for predicting SAP in clinical practice.

Highlights

Stroke-associated pneumonia (SAP) is one of the most common complications after acute ischemic stroke (AIS), with an incidence of 6.7–36.98% [1,2,3], and may lead to lengthy hospitalization, poor functional outcome, and high morbidity and mortality [2, 4,5,6,7]
We demonstrated that Monocyte-to-lymphocyte ratio (MLR) combined with the A2DS2 model could effectively predict the incidence of SAP
We found that AIS patients with older age, higher stroke severity, and dysphagia were more likely to acquire SAP, which was consistent with the previous studies [5]

Summary

Introduction

Stroke-associated pneumonia (SAP) is one of the most common complications after acute ischemic stroke (AIS), with an incidence of 6.7–36.98% [1,2,3], and may lead to lengthy hospitalization, poor functional outcome, and high morbidity and mortality [2, 4,5,6,7]. Due to the extra clinical and financial burden associated with SAP, it is necessary to explore underlying risk factors to aid with early recognition and prevention. Hoffmann et al developed and validated the A2DS2, a 10-point clinical model with high sensitivity and specificity for predicting SAP [3, 14, 15]. This model assesses risk factors, including age, atrial fibrillation, dysphagia, sex, and previous stroke severity. In a total of 3,160 Chinese AIS patients, Li et al [16] used machine learning methods to develop a model with high sensitivity and specificity to predict SAP. C57BL/6 mice treated with an anti-CD147 antibody could decrease the lung damages, bacterial load, and pulmonary edema after receiving middle cerebral artery occlusion [19]

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