Neutrophil to lymphocyte ratio at admission predicts in-hospital mortality risk in patients with acute ischemic stroke

Abstract

Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) at admission for mortality risk during hospitalization in patients with acute ischemic stroke (AIS). Methods Patients with AIS admitted to the Department of Neurology, the First Affiliated Hospital of China Medical University from January 2017 to December 2018 were enrolled retrospectively. The demographic data and all baseline clinical data were collected, and compared between the in-hospital death group and survival group. Multivariate logistic regression analysis was used to determine independent influencing factors for in-hospital death in patients with AIS. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of NLR for death during hospitalization. Results A total of 266 patients with AIS were enrolled, with an average age of 65 years, 168 were males (63.2%), 98 were females (36.8%), 52 died in hospital (19.5%), and 214 (80.5%) survived. The NLR of the death group was significantly higher than that of the survival group (median [interquartile range]: 7.6 [4.6-14.0] vs. 2.4 [1.8-4.0]; Z=7.727, P<0.001). Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.14; P=0.009), previous history of stroke or transient ischemic attack (OR 9.06, 95% CI 2.06-39.88; P=0.004), high NIHSS score (OR 1.13, 95% CI 1.04-1.24; P=0.004), and high NLR (OR 1.23, 95% CI 1.02-1.48; P=0.024) were the independent risk factors for death during hospitalization in patients with AIS. ROC curve analysis showed that the area under the curve of NLR predicting death during hospitalization for patients with AIS was 0.846 (95% CI 0.786-0.905; P<0.001). When the cut-off value of NLR was 4.52, the sensitivity and specificity were 76.9% and 80.8% respectively. The positive predictive value was 49.4%, and the negative predictive value was 93.5%. Conclusions The increased NLR level at admission had certain predictive value for the death of patients with AIS during hospitalization. Key words: Stroke; Brain ischemia; Neutrophils; Lymphocytes; Hospital mortality; Risk factors