Evaluation of Neutrophil-to-Lymphocyte Ratio Among Ischemic Stroke Subtypes and Stroke Severity

Abstract

Introduction: Recently, neutrophil-to-lymphocyte ratio (NLR) has been proven to be useful in predicting severity, mortality, and morbidity of stroke. NLR is low cost and yet not used widely as a biomarker to predict prognosis. Aims: We evaluated the association of NLR in severity of stroke and ischemic stroke subtypes. Methodology: A total of 69 subjects with ischemic stroke onset within 24 h were included in the study and categorized according to TOAST classification. National Institutes of Health Stroke Scale was used to determine stroke severity at admission. Samples were obtained within 24 h of stroke onset and NLR measured which was later correlated with severity and subtypes of stroke. Results: NLR and severity of stroke showed statistically significant association (P < .05). Median (interquartile range [IQR]) of NLR was significantly high in severe cases (7.1 [4.03-7.698]), as compared to others. The area under the receiver operating characteristic curve for NLR to predict the stroke severity was 6.07 [area under the curve 0.764; 95% confidence interval: 0.647 to 0.858). When NLR was more than 6.07, there was 90.90% chances of moderate-to-severe stroke and with milder stroke, 93.10% had NLR of less than equal to 6.07. NLR and stroke subtypes also showed statistically significant association (P < .05). Median (IQR) of NLR in embolic stroke was significantly high (4.75 [2.95-8.2]), as compared to other stroke subtypes. Conclusion: NLR, at a cut-off 6, has moderate sensitivity and higher specificity in predicting stroke severity and NLR was high in embolic stroke among other stroke subtypes.