Abstract
Ischemic and hemorrhagic strokes have multiple downstream consequences for patients. One of the most critical is poststroke infection (PSI). The goal of this systematic review and meta-analysis was to critically evaluate the literature regarding the use of the neutrophil to lymphocyte ratio (NLR) as a reliable means to detect early PSI development, particularly poststroke pneumonia (PSP) development to help clinicians institute early interventions and improve outcomes. The following were the inclusion criteria: (1) cross-sectional, case-control, and cohort studies; (2) studies comparing NLR data from PSI or PSP patients to controls; and (3) studies with a control group of stroke patients without infection. There was not any language or publication preference. The Newcastle-Ottawa Scale was used by two writers to assess the quality of the included studies. We assessed the certainty of the associations with GRADE methods. Web of Science, PubMed, and Scopus were searched, and 25 studies were included in the qualitative review. Among them, 15 studies were included in the meta-analysis. Standardized mean difference (SMD) was reported with a 95% confidence interval (CI) for the NLR levels. Patients with PSI had significantly higher NLR levels than stroke patients without infection (SMD = 1.08; CI 95% = 0.78‐1.39, P value < 0.001). In addition, the NLR levels of the stroke patients with pneumonia were significantly higher than those without pneumonia (SMD = 0.98; CI 95% = 0.81‐1.14, P value < 0.001). However, data extracted from the qualitative review suggested that NLR could not predict urinary tract infection, sepsis, or ventriculitis in stroke patients. Our study indicated that NLR could be recommended as an inexpensive biomarker for predicting infection, particularly pneumonia, in stroke patients. It can help clinicians institute early interventions that can reduce PSI and improve outcomes.
Highlights
It has been well documented in the cardiovascular literature that the neutrophil to lymphocyte ratio (NLR) is an important marker for clinical outcome [1]
The goal of this systematic review and meta-analysis was to consolidate the available data on the role of the NLR in predicting poststroke infection (PSI), poststroke pneumonia (PSP), to help guide further clinical management utilizing the predictive capabilities of the NLR
There has been a recent interest in determining the utility of the NLR as a diagnostic marker for predicting the development of PSP and other infections after stroke
Summary
It has been well documented in the cardiovascular literature that the neutrophil to lymphocyte ratio (NLR) is an important marker for clinical outcome [1]. Emerging data from the stroke literature has highlighted the importance of this ratio as a key marker for outcome [2]. The development of infection is one of the most crucial complications to diagnose early in the poststroke setting. This is critical to detect early as a lot Disease Markers of patients with stroke were previously health and nonsymptomatic. The goal of this systematic review and meta-analysis was to consolidate the available data on the role of the NLR in predicting PSI, PSP, to help guide further clinical management utilizing the predictive capabilities of the NLR
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