Immune biomarkers are associated with poststroke fatigue at six months in patients with ischemic stroke

Abstract

Poststroke fatigue (PSF) is detrimental to rehabilitation and the pathogenesis is still indefinite. The neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) are immune indicators reflecting the status of inflammation and nutrition and have been widely applied as prognostic biomarkers. We pointed to examine the connections between PSF and NLR, PNI in acute ischemic stroke patients. Between October 2020 and September 2021, 333 participants radiologically confirmed with first-ever ischemic stroke were enrolled from patients consecutively admitted to the Department of Neurology. Fatigue severity was evaluated by Fatigue Severity Scale (FSS) at 6 months after stroke. A total of 130 (39.0%) stroke survivors had PSF at 6 months after stroke. Patients in the PSF group had higher NLR and lower PNI on admission. The correlations between PSF and NLR (r = 0.750), and PNI (r = -0.685) were significant. In multivariate analyses, NLR (odds ratio [OR] = 11.132, 95% confidence internal [CI]:4.640–26.704, P < 0.001), PNI (OR = 0.420, 95%CI:0.292–0.603, P < 0.001), and self-rating depression scale score (OR = 1.125, 95%CI:1.028–1.232, P < 0.001) stayed as independent predictors for PSF at 6 months after adjusting potential confounders. With the Receiver Operating Characteristic curve, the areas under the curve were 0.898 (95%CI:0.862–0.934, P < 0.001), and 0.862 (95%CI:0.819–0.904, P < 0.001), respectively; and the optimal cut-off values of NLR and PNI that best identified PSF were 4.05 (sensitivity:70.8%, specificity:96.1%), and 48.4 (sensitivity:71.5%, specificity:90.1%), respectively. In conclusion, NLR and PNI on admission were independently associated with PSF at 6 months in ischemic stroke persons. NLR and PNI can be used to early screen individuals at high risk for PSF.