Predictive value of neutrophil to lymphocyte ratio at admission for large vessel occlusion in acute ischemic stroke

Abstract

Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) at admission for large vessel occlusion (LVO) in patients with acute ischemic stroke. Methods The clinical data of patients with acute ischemic stroke admitted to Guangzhou First People's Hospital from January 2016 to November 2017 were enrolled retrospectively. NLR was calculated according to results of blood routine examination within 6 h after admission. Multivariate logistic regression analysis was used to determine the independent correlation between NLR and LVO. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for LVO. Results A total of 109 patients with acute ischemic stroke were enrolled, including 42 females (38.5%) and 67 males (61.5%). Their mean age was 63.6 years. Forty-six patients (42.2%) had LVO. The proportions of patients with atrial fibrillation, previous stroke or transient ischemic attack, and the National Institutes of Health Stroke Scale score, white cell count, NLR, neutrophil count, and fasting blood glucose in the LVO group were significantly higher than those in the non-LVO group, while lymphocyte count was significantly lower than that in the non-LVO group (all P<0.05). Multivariate logistic regression analysis showed that NLR was an independent risk factor for LVO after adjusting for the confounding factors (odds ratio 2.768, 95% confidence interval, 2.272-4.984; P=0.001). The ROC curve analysis of NLR predicting LVO showed that the area under the curve was 0.712 (95% confidence interval 0.638-0.793), and the sensitivity and specificity were 79.3% and 73.6% respectively as the optimal cut-off value was 4.18. Conclusions Increased NLR in early peripheral blood may effectively predict LVO in acute ischemic stroke. Key words: Stroke; Brain Ischemia; Neutrophils; Lymphocytes; Leukocyte Count; Arterial Occlusive Diseases; Atherosclerosis