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Early neutrophil-to-lymphocyte ratio is a prognostic marker in acute minor stroke or transient ischemic attack

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Abstract

Intravenous injection of alteplase is recommended for patients with minor disabling and not non-disabling ischemic stroke symptoms within 4.5 h of ischemic stroke symptom onset. However, it is hard for clinicians to distinguish which type of minor ischemic stroke is disabled at an early stage. In this study, we aimed to demonstrate early neutrophil-to-lymphocyte ratio is a prognostic marker in acute minor stroke or transient ischemic attack. 196 patients diagnosed with acute minor stroke or transient ischemic attack within 24 h of symptom onset were enrolled. Patients were divided into three groups according to the neutrophil-to-lymphocyte ratio value (< 2, 2–3, > 3). Clinical, neuroradiological, laboratory and follow-up data were collected from electronic database. Functional outcome was assessed by modified Rankin Scale. Neutrophil-to-lymphocyte ratio associated with functional outcome of 90 days was evaluated by logistic regression analysis, and we used receiver operating characteristic curve analysis to detect the overall predictive accuracy of this marker. Early neutrophil-to-lymphocyte ratio was associated with an increased risk of short-term functional outcome (OR 4.502, 95% CI 1.533–13.046, P = 0.006). The optimal cutoff value of neutrophil-to-lymphocyte ratio for prediction of short-term unfavorable outcome was 2.94 with a sensitivity of 69.6% and a specificity of 77.1% (area under the curve: 0.767, 95% CI 0.691–0.843). Early neutrophil-to-lymphocyte ratio is associated with short-term unfavorable functional outcome in patients with acute minor stroke or transient ischemic attack. Early neutrophil-to-lymphocyte ratio is beneficial for clinicians to distinguish minor disabling ischemic stroke at an early stage.

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Funding

This study was funded by Natural Science Fund of Hubei Province (Grant number 2018CFB322), Health Research Project of Hubei Province, Science and Technology Development Plan of Jingzhou, New Project and New Technology Program of The First People’s Hospital of Jingzhou (Grant number 201826).

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Correspondence to Yi Luo or Qiang Tu.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were approved by the ethics committee of the first people’s hospital of Jingzhou, and were performed in accordance with the 1964 Declaration of Helsinki.

Informed consent

The board allowed the study to be conducted without patients' consent because of the retrospective nature of the study [11].

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Luo, Y., Xia, L., Li, Z. et al. Early neutrophil-to-lymphocyte ratio is a prognostic marker in acute minor stroke or transient ischemic attack. Acta Neurol Belg (2020). https://doi.org/10.1007/s13760-020-01289-3

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Keywords

  • Acute minor stroke
  • Lymphocyte
  • Neutrophil
  • Transient ischemic attack