Abstract
Background and Aims
High Neutrophil-to-Lymphocyte ratio (NLR) on admission has been associated with poor prognosis in acute ischemic stroke (AIS). Our goal was to investigate the predictive value of NLR and other clinical variables for post-stroke pneumonia (PSP).
Method
We retrospectively retrieved clinical and laboratory measures (absolute neutrophil count (ANC) and absolute lymphocyte count (ALC)) from the electronic record system of 192 patients with AIS who had routine blood sampling within 24h from onset. The NLR was defined as ANC/ALC. Patients were divided into 2 groups: those who developed pneumonia within the first week after admission (n = 30) and those who didn’t (n = 162). Logistic regression analysis and receiver operating characteristics (ROC) curves were used to identify predictors of PSP.
Results
At logistic regression analysis, male gender, severe dysarthria (NIHSS score 2), dysphagia and NLR were independent risk factors for PSP, with odds ratios (OR) of 3.4 (p = 0.025, 95% CI = 1.2–10.2), 8.5 (p = 0.005, 95% CI = 1.9–38.2), 7.8 (p = 0.001, 95% CI = 2.2–26.9) and 1.4 (p = 0.000, 95% CI = 1.2–1.7) respectively. A cut-off of 4.3 for NLR was determined on ROC curve (sensitivity = 70%, specificity = 79%). Area under the curve was 0.78 ± 0.05. Patients having an NLR above 4.3 are 11.9 times more at risk for PSP than patients with an NLR below 4.3 (OR = 11.9, p = 0.000, 95% CI = 3.8–36.9). Cross-validation (67/33% validation training set) showed misclassification probability of 12.6%-21.8%.
Conclusion
Our results suggest that NLR, dysphagia, dysarthria and male gender are independent predictors of PSP within the first week after stroke onset.
High Neutrophil-to-Lymphocyte ratio (NLR) on admission has been associated with poor prognosis in acute ischemic stroke (AIS). Our goal was to investigate the predictive value of NLR and other clinical variables for post-stroke pneumonia (PSP).
Method
We retrospectively retrieved clinical and laboratory measures (absolute neutrophil count (ANC) and absolute lymphocyte count (ALC)) from the electronic record system of 192 patients with AIS who had routine blood sampling within 24h from onset. The NLR was defined as ANC/ALC. Patients were divided into 2 groups: those who developed pneumonia within the first week after admission (n = 30) and those who didn’t (n = 162). Logistic regression analysis and receiver operating characteristics (ROC) curves were used to identify predictors of PSP.
Results
At logistic regression analysis, male gender, severe dysarthria (NIHSS score 2), dysphagia and NLR were independent risk factors for PSP, with odds ratios (OR) of 3.4 (p = 0.025, 95% CI = 1.2–10.2), 8.5 (p = 0.005, 95% CI = 1.9–38.2), 7.8 (p = 0.001, 95% CI = 2.2–26.9) and 1.4 (p = 0.000, 95% CI = 1.2–1.7) respectively. A cut-off of 4.3 for NLR was determined on ROC curve (sensitivity = 70%, specificity = 79%). Area under the curve was 0.78 ± 0.05. Patients having an NLR above 4.3 are 11.9 times more at risk for PSP than patients with an NLR below 4.3 (OR = 11.9, p = 0.000, 95% CI = 3.8–36.9). Cross-validation (67/33% validation training set) showed misclassification probability of 12.6%-21.8%.
Conclusion
Our results suggest that NLR, dysphagia, dysarthria and male gender are independent predictors of PSP within the first week after stroke onset.
| Original language | English |
|---|---|
| Pages (from-to) | 3-204 |
| Journal | European Stroke Journal |
| Volume | 3 |
| Issue number | 1 |
| Publication status | Published - 16 May 2018 |
| Event | 4th European Stroke Organisation Conference - Gothenburg, Gothenburg, Sweden Duration: 16 May 2018 → 18 May 2018 https://eso-conference.org/2018/Pages/default.aspx#.WrtXndK7r4Y |
Keywords
- Neutrophil-to-lymphocyte ratio
- Post-stroke pneumonia
- Acute Ischemic stroke