The Association of the Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio and Systemic Inflammation Response Index with Short-Term Functional Outcome in Patients with Acute Ischemic Stroke

Abstract

Background and Purpose

The aim of this study was to explore the relationship between functional prognosis and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic inflammatory response index (SIRI) in patients with acute ischemic stroke (AIS) at discharge.

Methods

A total of 861 patients with AIS were enrolled between January 2019 and December 2021. Blood cell counts were collected on admission. Logistic regression analysis was performed to assess the relationship between NLR, PLR, LMR, SIRI and adverse functional outcomes (modified Rankin scale score of 3–6) at discharge. We also used receiver operating characteristic (ROC) curves to estimate the overall ability of NLR, PLR, LMR and SIRI to judge short-term functional outcomes. Associations between NLR, PLR, LMR, and SIRI with length of hospital stay were analyzed by Spearman correlation test.

Results

A total of 194 patients (22.5%) had poor functional outcomes at discharge. Multivariate logistic regression analysis showed that NLR (odds ratio [OR], 1.060; 95% confidence interval [CI] 1.004–1.120, P=0.037), PLR (OR, 1.003; 95% CI 1.000–1.005, P=0.018), LMR (OR, 0.872; 95% CI 0.774–0.981, P=0.023) and SIRI (OR, 1.099; 95% CI 1.020–1.184, P=0.013) were independent factors for poor functional outcome. The odds ratios of the highest versus lowest quartiles of NLR, PLR and SIRI were 2.495 (95% CI 1.394–4.466), 1.959 (95% CI 1.138–3.373) and 1.866 (95% CI 1.106–3.146), respectively. The odds ratio of the lowest versus highest quartile of LMR was 2.300 (95% CI 1.331–3.975). The areas under the curve (AUCs) of the NLR, PLR, LMR, and SIRI to discriminate poor functional prognosis were 0.644, 0.587, 0.628, and 0.651, respectively. NLR, LMR, and SIRI were related with the length of hospital stay (P<0.05).

Conclusion

NLR, PLR, LMR, and SIRI were associated with functional outcome at discharge in AIS patients. NLR, LMR and SIRI were related to hospitalization days in patients with AIS.

Keywords:

• acute ischemic stroke
• short-term functional outcome
• neutrophil-to-lymphocyte ratio
• platelet-to-lymphocyte ratio
• lymphocyte-to-monocyte ratio
• systemic inflammatory response index

Abbreviations

AIS, acute ischemic stroke; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; SIRI, systemic inflammatory response index; mRS, modified Rankin scale score; NIHSS, National Institutes of Health Stroke Scale; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; LDL, low-density lipoprotein; GLU, plasma glucose; ROC receiver operating characteristic; AUC, areas under the curve.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

This study was approved by the Ethics Committee of the First Hospital of Hebei Medical University (approval number: 20200908). The fully deidentified data on the patients enrolled in the current study and its retrospective study design enabled this study to be conducted under waiver of informed consent by the local institutional review board. Our study also complied with the Declaration of Helsinki.

Consent for Publication

All the authors agree to publish.

Acknowledgments

We express our gratitude to all the researchers and patients who participated in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This study was supported by Hebei Natural Science Foundation (H2020206632) and National Key Research and Development Program of China (2022YFC3600503).