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Nowaczewska-Kuchta A, Ksiazek-Winiarek D, Szpakowski P, Glabinski A. The Role of Neutrophils in Multiple Sclerosis and Ischemic Stroke. Brain Sci 2024; 14:423. [PMID: 38790402 PMCID: PMC11118671 DOI: 10.3390/brainsci14050423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Inflammation plays an important role in numerous central nervous system (CNS) disorders. Its role is ambiguous-it can induce detrimental effects, as well as repair and recovery. In response to injury or infection, resident CNS cells secrete numerous factors that alter blood-brain barrier (BBB) function and recruit immune cells into the brain, like neutrophils. Their role in the pathophysiology of CNS diseases, like multiple sclerosis (MS) and stroke, is highly recognized. Neutrophils alter BBB permeability and attract other immune cells into the CNS. Previously, neutrophils were considered a homogenous population. Nowadays, it is known that various subtypes of these cells exist, which reveal proinflammatory or immunosuppressive functions. The primary goal of this review was to discuss the current knowledge regarding the important role of neutrophils in MS and stroke development and progression. As the pathogenesis of these two disorders is completely different, it gives the opportunity to get insight into diverse mechanisms of neutrophil involvement in brain pathology. Our understanding of the role of neutrophils in CNS diseases is still evolving as new aspects of their activity are being unraveled. Neutrophil plasticity adds another level to their functional complexity and their importance for CNS pathophysiology.
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Affiliation(s)
| | | | | | - Andrzej Glabinski
- Department of Neurology and Stroke, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland; (A.N.-K.); (D.K.-W.); (P.S.)
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Mishra A, Tandon R, Paliwal V, Jha S. How well does peripheral blood neutrophil-to-lymphocyte ratio predict the severity and prognosis of hemorrhagic Stroke. Clin Neurol Neurosurg 2024; 239:108211. [PMID: 38452715 DOI: 10.1016/j.clineuro.2024.108211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE We explored the blood neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker and its relation with mortality and Modified Rankin Scale (mRS) score at discharge and at 3 months following ICH and also compared NLR with intracerebral hemorrhage (ICH) score, Sequential Organ Failure Assessment (SOFA) score and National Institutes of Health Stroke Scale (NIHSS) score. METHODS The investigators calculated the NIHSS score, SOFA score, ICH score and NLR of 90 adult patients within 3 days of onset of stroke with evidence of hemorrhagic stroke in brain imaging and correlated it with in-hospital mortality, 3-month mortality and mRS at 3 months following stroke using regression analysis. RESULTS Out of 90 individuals, there were 54 (60%) males and 36 (40%) females. The mRS score at 3 months significantly related to the admission NLR ratio >7 and SOFA score. Similarly, the in-hospital death and 3-month mortality was related to the admission NLR ratio >7 and ICH score. However, at a cut off value of NLR>3 for assessing the prognosis of the patients, we did not get significant results for mRS at 3 months following stroke and for in-hospital and 3-month mortality. CONCLUSION A high NLR ratio >7 predicted worse outcomes in terms of mortality and morbidity at 3-months following haemorrhagic stroke. Hence, like ICH score, NLR can predict 3-month mortality following an acute haemorrhagic stroke and can also predict morbidity following 3 months of brain haemorrhage.
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Affiliation(s)
- Anadi Mishra
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ruchika Tandon
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
| | - Vimal Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sanjeev Jha
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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Liu S, Zhang Z, He Y, Kong L, Jin Q, Qi X, Qi D, Gao Y. Inhibiting leukocyte-endothelial cell interactions by Chinese medicine Tongxinluo capsule alleviates no-reflow after arterial recanalization in ischemic stroke. CNS Neurosci Ther 2023; 29:3014-3030. [PMID: 37122157 PMCID: PMC10493667 DOI: 10.1111/cns.14242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023] Open
Abstract
AIMS Despite successful vascular recanalization in stroke, one-fourth of patients have an unfavorable outcome due to no-reflow. The pathogenesis of no-reflow is fully unclear, and therapeutic strategies are lacking. Upon traditional Chinese medicine, Tongxinluo capsule (TXL) is a potential therapeutic agent for no-reflow. Thus, this study is aimed to investigate the pathogenesis of no-reflow in stroke, and whether TXL could alleviate no-reflow as well as its potential mechanisms of action. METHODS Mice were orally administered with TXL (3.0 g/kg/d) after transient middle cerebral artery occlusion. We examined the following parameters: neurological function, no-reflow, leukocyte-endothelial cell interactions, HE staining, leukocyte subtypes, adhesion molecules, and chemokines. RESULTS Our results showed stroke caused neurological deficits, neuron death, and no-reflow. Adherent and aggregated leukocytes obstructed microvessels as well as leukocyte infiltration in ischemic brain. Leukocyte subtypes changed after stroke mainly including neutrophils, lymphocytes, regulatory T cells, suppressor T cells, helper T type 1 (Th1) cells, Th2 cells, B cells, macrophages, natural killer cells, and dendritic cells. Stroke resulted in upregulated expression of adhesion molecules (P-selectin, E-selectin, and ICAM-1) and chemokines (CC-chemokine ligand (CCL)-2, CCL-3, CCL-4, CCL-5, and chemokine C-X-C ligand 1 (CXCL-1)). Notably, TXL improved neurological deficits, protected neurons, alleviated no-reflow and leukocyte-endothelial cell interactions, regulated multiple leukocyte subtypes, and inhibited the expression of various inflammatory mediators. CONCLUSION Leukocyte-endothelial cell interactions mediated by multiple inflammatory factors are an important cause of no-reflow in stroke. Accordingly, TXL could alleviate no-reflow via suppressing the interactions through modulating various leukocyte subtypes and inhibiting the expression of multiple inflammatory mediators.
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Affiliation(s)
- Shen Liu
- Department of Neurology of TCM, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
- Department of Rehabilitation MedicineThe First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan HospitalJinanChina
| | - Zhaoxu Zhang
- Department of NeurologyPeking University People's HospitalBeijingChina
| | - Yannan He
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
| | - Lingbo Kong
- Department of Neurology of TCM, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
| | - Qiushuo Jin
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
| | - Xiangjia Qi
- Department of NeurologyThe First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan HospitalJinanChina
| | - Dahe Qi
- Department of Neurology of TCM, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
| | - Ying Gao
- Department of Neurology of TCM, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
- Institute for Brain Disorders, Beijing University of Chinese MedicineBeijingChina
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Shusterman E, Prozan L, Ablin JN, Weiss-Meilik A, Adler A, Choshen G, Kehat O. Neutrophil-to-lymphocyte ratio trend at admission predicts adverse outcome in hospitalized respiratory syncytial virus patients. Heliyon 2023; 9:e16482. [PMID: 37251466 PMCID: PMC10220360 DOI: 10.1016/j.heliyon.2023.e16482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
Background and aims Severe cases of respiratory syncytial virus (RSV) infection are relatively rare but may lead to serious clinical outcomes, including respiratory failure and death. These infections were shown to be accompanied by immune dysregulation. We aimed to test whether the admission neutrophil-to-leukocyte ratio, a marker of an aberrant immune response, can predict adverse outcome. Methods We retrospectively analyzed a cohort of RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020d. Laboratory, demographic and clinical parameters were collected. Two-way analysis of variance was used to test the association between neutrophil-lymphocyte ratio (NLR) values and poor outcomes. Receiver operating characteristic (ROC) curve analysis was applied to test the discrimination ability of NLR. Results In total, 482 RSV patients (median age 79 years, 248 [51%] females) were enrolled. There was a significant interaction between a poor clinical outcome and a sequential rise in NLR levels (positive delta NLR). The ROC curve analysis revealed an area under curve (AUC) of poor outcomes for delta NLR of (0.58). Using a cut-off of delta = 0 (the second NLR is equal to the first NLR value), multivariate logistic regression identified a rise in NLR (delta NLR>0) as being a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score, with an odds ratio of 1.914 (P = 0.014) and a total AUC of 0.63. Conclusions A rise in NLR levels within the first 48 h of hospital admission can serve as a prognostic marker for adverse outcome.
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Affiliation(s)
- Eden Shusterman
- Internal Medicine H, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Lior Prozan
- Internal Medicine H, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Jacob Nadav Ablin
- Internal Medicine H, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Amos Adler
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Guy Choshen
- Internal Medicine H, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
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Stephens R, Grainger JR, Smith CJ, Allan SM. Systemic innate myeloid responses to acute ischaemic and haemorrhagic stroke. Semin Immunopathol 2023; 45:281-294. [PMID: 36346451 PMCID: PMC9641697 DOI: 10.1007/s00281-022-00968-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
Acute ischaemic and haemorrhagic stroke account for significant disability and morbidity burdens worldwide. The myeloid arm of the peripheral innate immune system is critical in the immunological response to acute ischaemic and haemorrhagic stroke. Neutrophils, monocytes, and dendritic cells (DC) contribute to the evolution of pathogenic local and systemic inflammation, whilst maintaining a critical role in ongoing immunity protecting against secondary infections. This review aims to summarise the key alterations to myeloid immunity in acute ischaemic stroke, intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH). By integrating clinical and preclinical research, we discover how myeloid immunity is affected across multiple organ systems including the brain, blood, bone marrow, spleen, and lung, and evaluate how these perturbations associate with real-world outcomes including infection. These findings are placed in the context of the rapidly developing field of human immunology, which offers a wealth of opportunity for further research.
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Affiliation(s)
- Ruth Stephens
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - John R Grainger
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Craig J Smith
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Stuart M Allan
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK.
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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Zhao J, Feng J, Ma Q, Li C, Qiu F. Prognostic value of inflammation biomarkers for 30-day mortality in critically ill patients with stroke. Front Neurol 2023; 14:1110347. [PMID: 36814998 PMCID: PMC9939760 DOI: 10.3389/fneur.2023.1110347] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023] Open
Abstract
Objective To explore the values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), neutrophil to albumin ratio (NAR), prognostic nutritional index (PNI), systemic immune inflammatory index (SII) and red cell distribution width to albumin ratio (RA) for evaluating the risk of 30-day mortality of ischemic stroke or hemorrhagic stroke patients. Methods In this cohort study, the data of 1,601 patients diagnosed with stroke were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Among them, 908 were hemorrhagic stroke patients and 693 were ischemic stroke patients. Demographic and clinical variables of patients were collected. Univariate and multivariable Cox regression were performed to evaluate the predictive values of NLR, PLR, SII, NAR, RA, and PNI for 30-day mortality in hemorrhagic stroke or ischemic stroke patients. The receiver operator characteristic (ROC) curves were plotted to assess the predictive values of NLR, NAR, and RA for 30-day mortality of hemorrhagic stroke patients. Results At the end of follow-up, 226 hemorrhagic stroke patients and 216 ischemic stroke patients died. The elevated NLR level was associated with increased risk of 30-day mortality in hemorrhagic stroke [hazard ratio (HR) = 1.17, 95% confidence interval (CI): 1.06-1.29]. The increased NAR level was associated with elevated risk of 30-day mortality in hemorrhagic stroke (HR = 1.16, 95% CI: 1.02-1.30). The high RA level was linked with increased risk of 30-day mortality (HR = 1.44, 95% CI: 1.23-1.69). No significant correlation was observed in these inflammation biomarkers with the risk of 30-day mortality in ischemic stroke patients. The area under the curves (AUCs) of NLR, RA, and NAR for evaluating the risk of 30-day mortality of hemorrhagic stroke patients were 0.552 (95% CI: 0.503-0.601), 0.644 (95% CI: 0.590-0.699) and 0.541 (95% CI: 0.490-0.592). Conclusion NLR, NAR, and RA were potential prognostic biomarkers for predicting 30-day mortality of hemorrhagic stroke patients, which might provide clinicians an easy and cheap way to quickly identify patients with high risk of mortality.
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Affiliation(s)
- Jun Zhao
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jinli Feng
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Qian Ma
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chunlin Li
- Department of Health Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China,Chunlin Li ✉
| | - Feng Qiu
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China,*Correspondence: Feng Qiu ✉
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Hey G, Bhutani S, Woolridge M, Patel A, Walls A, Lucke-Wold B. Immunologic Implications for Stroke Recovery: Unveiling the Role of the Immune System in Pathogenesis, Neurorepair, and Rehabilitation. JOURNAL OF CELLULAR IMMUNOLOGY 2023; 5:65-81. [PMID: 37854481 PMCID: PMC10583807 DOI: 10.33696/immunology.5.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Stroke is a debilitating neurologic condition characterized by an interruption or complete blockage of blood flow to certain areas of the brain. While the primary injury occurs at the time of the initial ischemic event or hemorrhage, secondary injury mechanisms contribute to neuroinflammation, disruption of the blood-brain barrier (BBB), excitotoxicity, and cerebral edema in the days and hours after stroke. Of these secondary mechanisms of injury, significant dysregulation of various immune populations within the body plays a crucial role in exacerbating brain damage after stroke. Pathological activity of glial cells, infiltrating leukocytes, and the adaptive immune system promote neuroinflammation, BBB damage, and neuronal death. Chronic immune activation can additionally encourage the development of neurologic deficits, immunosuppression, and dysregulation of the gut microbiome. As such, immunotherapy has emerged as a promising strategy for the clinical management of stroke in a highly patient-specific manner. These strategies include regulatory T cells (Tregs), cell adhesion molecules, cytokines, and monoclonal antibodies. However, the use of immunotherapy for stroke remains largely in the early stages, highlighting the need for continued research efforts before widespread clinical use.
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Affiliation(s)
- Grace Hey
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Siya Bhutani
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Maxwell Woolridge
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aashay Patel
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Anna Walls
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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Correlation between the Neutrophil-to-Lymphocyte Ratio and Multiple Sclerosis: Recent Understanding and Potential Application Perspectives. Neurol Res Int 2022; 2022:3265029. [PMID: 36340639 PMCID: PMC9629953 DOI: 10.1155/2022/3265029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/28/2022] [Accepted: 10/15/2022] [Indexed: 11/28/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic debilitating immune-mediated disease of the central nervous system, which causes demyelination and neuroaxonal damage. Low-grade systemic inflammation has been considered to lead to pathogenesis owing to the amplification of pathogenic immune response activation. However, there is a shortage of reliable systemic inflammatory biomarkers to predict the disease activity and progression of MS. In MS patients, a series of cytokines and chemokines promote the proliferation of neutrophils and lymphocytes and their transfer to the central nervous system. The neutrophil-to-lymphocyte ratio (NLR), which combines the information of the inherent and adaptive parts of the immune system, represents a reliable measure of the inflammatory burden. In this review, we aimed to discuss the inflammatory response in MS, mainly the function of lymphocytes and neutrophils, which can be implemented in the utility of NLR as a diagnostic tool in MS patients. The underlying pathophysiology is highlighted to identify new potential targets for neuroprotection and to develop novel therapeutic strategies.
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Contaldi E, Magistrelli L, Cosentino M, Marino F, Comi C. Lymphocyte Count and Neutrophil-to-Lymphocyte Ratio Are Associated with Mild Cognitive Impairment in Parkinson’s Disease: A Single-Center Longitudinal Study. J Clin Med 2022; 11:jcm11195543. [PMID: 36233411 PMCID: PMC9571051 DOI: 10.3390/jcm11195543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Lymphocyte count and neutrophil-to-lymphocyte ratio (NLR) may represent useful biomarkers of Parkinson’s disease (PD), but their role in PD-related mild cognitive impairment (MCI) has not been fully elucidated. The present study aimed to confirm whether these immunological measures can discriminate PD patients from healthy controls (HC) and establish their feasibility as prognostic biomarkers of MCI in PD. Immunological data at baseline were analyzed in 58 drug-naïve PD patients and 58 HC matched 1:1 for age, sex, and cardiovascular comorbidities. We selected a subgroup of 51 patients from this initial cohort who underwent longitudinal neuropsychological assessments through the Addenbrooke’s Cognitive Examination Revised (ACE-R) test. We considered the last examination available to analyze the relationship between ACE-R test scores and immunological measures. We found that lymphocyte count was lower and NLR higher in PD than HC (p = 0.006, p = 0.044), with AUC = 0.649 and 0.608, respectively. Secondly, in PD-MCI there were significantly higher levels of circulating lymphocytes (p = 0.002) and lower NLR (p = 0.020) than PD with normal cognitive status (PD-NC). Correlations between lymphocyte count and ACE-R total score and memory subitem (r = −0.382, p = 0.006; r = −0.362, p = 0.01), as well as between NLR and ACE-R total score and memory subitem (r = 0.325, p = 0.02; r = 0.374, p = 0.007), were also found. ROC curve analysis showed that lymphocyte count and NLR displayed acceptable discrimination power of PD-MCI with AUC = 0.759 and 0.691, respectively. In conclusion, we suggest that an altered peripheral immune phenotype could foster cognitive decline development in PD, thus opening the possibility of immune-targeting strategies to tackle this disabling non-motor feature.
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Affiliation(s)
- Elena Contaldi
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- PhD Program in Medical Sciences and Biotechnology, University of Piemonte Orientale, 28100 Novara, Italy
| | - Luca Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, 21100 Varese, Italy
| | - Marco Cosentino
- Center of Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
- Center for Research in Neuroscience, University of Insubria, 21100 Varese, Italy
| | - Franca Marino
- Center of Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
- Center for Research in Neuroscience, University of Insubria, 21100 Varese, Italy
| | - Cristoforo Comi
- Center of Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy
- Department of Translational Medicine, Neurology Unit, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
- Correspondence:
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Ye Z, Hu T, Wang J, Xiao R, Liao X, Liu M, Sun Z. Systemic immune-inflammation index as a potential biomarker of cardiovascular diseases: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:933913. [PMID: 36003917 PMCID: PMC9393310 DOI: 10.3389/fcvm.2022.933913] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several studies have investigated the value of the systemic immune-inflammation index (SII) for predicting cardiovascular disease (CVD), but the results were inconsistent. Therefore, a meta-analysis and systematic review were conducted to assess the correlation between SII and risk of CVD. Materials and methods Two investigators systematically searched PubMed, Embase, Web of Science, Cochrane library, and CINAHL databases to identify all studies that examined the association between SII levels and CVD. The risk estimates of CVD for people with high SII compared to those with low SII levels and the weighted mean difference (WMD) between the CVD and control groups were pooled using fixed- or random-effects models based on the heterogeneity test. We used the Newcastle-Ottawa Scale to assess the risk of bias in eligible studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was applied to rate the certainty of evidence. Results A total of 13 studies with 152,996 participants were included for analysis. The overall pooled results showed that higher SII was significantly associated with an increased risk of CVD (HR = 1.39, 95%CI: 1.20–1.61, P < 0.001). This increased risk could be observed in almost all CVD subtypes, including ischemic stroke (HR = 1.31, 95%CI: 1.06–1.63, P = 0.013), hemorrhagic stroke (HR = 1.22, 95%CI: 1.10–1.37, P < 0.001), myocardial infarction (HR = 1.11, 95%CI: 1.01–1.23, P = 0.027), and peripheral arterial disease (HR = 1.51, 95%CI: 1.18–1.93, P = 0.001). There were no significant but still similar trends in venous thrombosis (HR = 4.65, 95%CI: 0.66–32.71, P = 0.122), cerebral small vessel disease (HR = 1.09, 95%CI: 0.95–1.25, P = 0.233), and acute coronary syndrome (HR = 1.08, 95%CI: 0.96–1.22, P = 0.200). Furthermore, the pooled results showed that SII levels at the onset of CVD were significantly higher than that in the general population (WMD = 355.2, 95%CI: 234.8–475.6, P < 0.001), which was consistent across different CVD subtypes. The GRADE assessment suggested that the quality of current evidence from observational studies was low or very low. Conclusion This study indicated that SII may be a potential biomarker for CVD development and elevated SII is associated with an increased risk of CVD. However, the quality of evidence is generally low. Additional well-designed studies are necessary to determine the optimal cutoff value and to characterize the benefited population.
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Affiliation(s)
- Zhen Ye
- Hengyang Medical School, University of South China, Hengyang, China
| | - Tingyi Hu
- Department of Emergency Medicine, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jin Wang
- Hengyang Medical School, University of South China, Hengyang, China
| | - Ruoyi Xiao
- Hengyang Medical School, University of South China, Hengyang, China
| | - Xibei Liao
- Hengyang Medical School, University of South China, Hengyang, China
| | - Mengsi Liu
- Hengyang Medical School, University of South China, Hengyang, China
| | - Zhen Sun
- Hengyang Medical School, University of South China, Hengyang, China
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11
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Wang N, Yang Y, Qiu B, Gao Y, Wang A, Xu Q, Meng X, Xu Y, Song B, Wang Y, Wang Y. Correlation of the systemic immune-inflammation index with short- and long-term prognosis after acute ischemic stroke. Aging (Albany NY) 2022; 14:6567-6578. [PMID: 35985678 PMCID: PMC9467411 DOI: 10.18632/aging.204228] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/01/2022] [Indexed: 01/05/2023]
Abstract
Immune and inflammatory responses after stroke are important pathophysiological processes. This study explored the relationship between the systemic immune-inflammation index (SII) and stroke prognosis. Patients from the China National Stroke Registry III were investigated. SII was defined as neutrophils × platelets/lymphocytes, and the patients were divided into four groups according to quartiles based on SII values. The primary outcome was poor functional outcome, assessed by the modified Rankin Scale (mRS), defined as an mRS score of ≥3. The secondary outcome was the incidence of all-cause death and recurrent stroke. Data were analyzed using either the logistic regression or Cox regression models. As the SII quartile increased, the percentage of patients with poor functional outcomes increased: 178 (7.8%), 223 (9.8%), 292 (12.8%), and 417 (18.3%) (P < 0.0001) at the 90-day follow-up and 172 (7.6%), 203 (8.9%), 266 (11.7%), and 386 (17.0%) (P < 0.0001) at the 1-year follow-up. Compared to patients in the quartile (Q)1 group, those in the Q4 group had a higher risk for adverse events, especially all-cause death at the 90-day follow-up (adjusted hazard ratio [HR], 2.409; 95% confidence interval [CI], 1.273–4.559, P = 0.0069) and at the 1-year follow-up visits (adjusted HR, 2.209; 95% CI, 1.474–3.311, P = 0.0001). The SII was closely related to the short- and long-term prognosis of patients with acute ischemic stroke, and patients with higher SIIs were more likely to have poor outcomes.
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Affiliation(s)
- Nan Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Henan, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Baoshan Qiu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Ying Gao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
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12
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Zhang RX, Zhang WW, Luo YT, Liu GW. An mNUTRIC-based nomogram for predicting the in-hospital death risk in patients with acute stroke. Eur J Clin Nutr 2022; 76:1464-1469. [DOI: 10.1038/s41430-022-01127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/09/2022]
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13
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Khanzadeh S, Lucke-Wold B, Eshghyar F, Rezaei K, Clark A. The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis. DISEASE MARKERS 2022; 2022:1983455. [PMID: 35313569 PMCID: PMC8934208 DOI: 10.1155/2022/1983455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 02/08/2023]
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.
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Affiliation(s)
- Shokoufeh Khanzadeh
- 1Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Eshghyar
- 3Tehran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Katayoun Rezaei
- 4Student Research Committee, University of Kharazmi, Karaj, Iran
| | - Alec Clark
- 5University of Central Florida, School of Medicine, Orlando, USA
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14
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Kara SP, Altunan B, Unal A. Investigation of the peripheral inflammation (neutrophil-lymphocyte ratio) in two neurodegenerative diseases of the central nervous system. Neurol Sci 2022; 43:1799-1807. [PMID: 34331157 PMCID: PMC8324446 DOI: 10.1007/s10072-021-05507-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Alzheimer's disease (AD), and idiopathic Parkinson's disease (IPD) are the neurodegenerative diseases of the central nervous system (CNS). Cognitive impairment is on the forefront in AD. However, IPD is a movement disorder. Inflammation was suggested to have an effect in the pathophysiology of these two diseases. Neutrophil-lymphocyte ratio (NLR) was shown to be a possible marker showing the peripheral inflammation. We aimed to investigate the NLR of patiens with the diagnosis of AD, and IPD, and individuals with no neurodegenerative disease. MATERIALS AND METHODS A total of 100 patients with the diagnosis of IPD, and 94 with diagnosis of AD, and 61 healthy controls were included into the study. All the demographic, clinical, and laboratory data were retrospectively obtained from the hospital automated database system. RESULTS The NLR in the IPD group was found statistically significantly higher compared with the control group and the AD group (p < 0.001, p = 0.04, respectively). The age-adjusted values were statistically analyzed because of age difference. No statistically significant difference was detected between AD and control groups in terms of NLR (p = 0.6). The age-adjusted NLR value in the Parkinson's group was found significantly higher compared to the control group (p = 0.02) and Alzheimer's group (p = 0.03). DISCUSSION Chronic inflammation has an important role in the emergence and progression of the chronic neurodegenerative diseases of the CNS. Our results show that the inflammation in the peripheral blood in IPD was more significant compared with the inflammation in AD.
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Affiliation(s)
- Sonat Pınar Kara
- Faculty of Medicine, Department of Internal Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Bengü Altunan
- Faculty of Medicine, Department of Neurology, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Aysun Unal
- Faculty of Medicine, Department of Neurology, Tekirdag Namik Kemal University, Tekirdag, Turkey
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15
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Yu Y, Cui WH, Cheng C, Lu Y, Zhang Q, Han RQ. Association between neutrophil-to-lymphocyte ratio and major postoperative complications after carotid endarterectomy: A retrospective cohort study. World J Clin Cases 2021; 9:10816-10827. [PMID: 35047593 PMCID: PMC8678856 DOI: 10.12998/wjcc.v9.i35.10816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/27/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carotid artery cross-clamping during carotid endarterectomy (CEA) may damage local cerebral perfusion and induce cerebral ischemia–reperfusion injury to activate local inflammatory responses. Neutrophil-to-lymphocyte ratio (NLR) is an indicator that reflects systemic inflammation. However, the correlation between NLR and complications after CEA remains unclear.
AIM To investigate the association between NLR and major complications after surgery in patients undergoing CEA.
METHODS This retrospective cohort study included patients who received CEA between January 2016 and July 2018 at Beijing Tiantan Hospital. Neutrophil and lymphocyte counts in whole blood within 24 h after CEA were collected. The primary outcome was the composite of major postoperative complications including neurological, pulmonary, cardiovascular and acute kidney injuries. The secondary outcomes included infections, fever, deep venous thrombosis, length of hospitalization and cost of hospitalization. Statistical analyses were performed using EmpowerStats software and R software.
RESULTS A total of 224 patients who received CEA were screened for review and 206 were included in the statistical analyses; of whom, 40 (19.42%) developed major postoperative complications. NLR within 24 h after CEA was significantly correlated with major postoperative complications (P = 0.026). After confounding factors were adjusted, the odds ratio was 1.15 (95%CI: 1.03–1.29, P = 0.014). The incidence of major postoperative complications in the high NLR group was 8.47 times that in the low NLR group (P = 0.002).
CONCLUSION NLR is associated with major postoperative complications in patients undergoing CEA.
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Affiliation(s)
- Yun Yu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Wei-Hua Cui
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Chan Cheng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yu Lu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Qing Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ru-Quan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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16
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Lombardi G, Paganelli R, Abate M, Ireland A, Molino-Lova R, Sorbi S, Macchi C, Pellegrino R, Di Iorio A, Cecchi F. Leukocyte-derived ratios are associated with late-life any type dementia: a cross-sectional analysis of the Mugello study. GeroScience 2021; 43:2785-2793. [PMID: 34674153 PMCID: PMC8529862 DOI: 10.1007/s11357-021-00474-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/11/2021] [Indexed: 11/01/2022] Open
Abstract
Immunosenescence, vascular aging, and brain aging, all characterized by elevated levels of inflammatory markers, are thought to share a common pathogenetic pathway: inflamm-aging. Retrospective cross-sectional analysis was conducted using data from the Mugello study (Tuscany, Italy), a representative Italian cohort of free-living nonagenarians. to assess the association between specific peripheral inflammation markers derived from white blood cell counts, and the diagnosis of dementia. All the variables of interest were reported for 411 subjects (110 males and 301 females) out of 475 enrolled in the study. Anamnestic dementia diagnosis was obtained from clinical certificate and confirmed by a General Practitioner, whereas leukocyte ratios were directly calculated from white blood cell counts. Body mass index and comorbidities were considered potential confounders. Diagnosis of any type dementia was certified in 73 cases (17.8%). Subjects affected by dementia were older, more frequently reported a previous stroke, had lower body mass index, and lower Mini-Mental-State-Examination score. Moreover, they had a higher lymphocyte count and lymphocyte-to-monocyte ratio compared to the non-demented nonagenarians. We found that higher levels of lymphocyte counts are cross-sectionally associated with a clinical diagnosis of dementia. Furthermore, lymphocyte-to-monocyte ratio is directly associated with any type of dementia, independently of age, sex, lymphocyte count, and comorbidities. Lymphocyte-to-monocyte ratio may be considered a marker of immunological changes in the brain of dementia patients; moreover, it is low-cost, and easily available, thus enabling comparisons among different studies and populations, although the timeline and the extent of lymphocyte-to-monocyte ratio role in dementia development must be further investigated.
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Affiliation(s)
- Gemma Lombardi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Roberto Paganelli
- Department of Medicine and Science of Aging, Laboratory of Clinical Epidemiology and Aging, University Centre of Sports Medicine, University "G. d'Annunzio, Viale Abruzzo 322, Chieti, Italy.,Institute of Clinical Immunotherapy and Advanced Biological Treatments, YDA, Pescara, Italy
| | - Michele Abate
- Department of Medicine and Science of Aging, Laboratory of Clinical Epidemiology and Aging, University Centre of Sports Medicine, University "G. d'Annunzio, Viale Abruzzo 322, Chieti, Italy
| | - Alex Ireland
- Department of Life Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK
| | - Raffaele Molino-Lova
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, Università Di Firenze, Largo Brambilla 3, 50100, Florence, Italy
| | - Raffaello Pellegrino
- Department of Medicine and Science of Aging, Laboratory of Clinical Epidemiology and Aging, University Centre of Sports Medicine, University "G. d'Annunzio, Viale Abruzzo 322, Chieti, Italy
| | - Angelo Di Iorio
- Department of Medicine and Science of Aging, Laboratory of Clinical Epidemiology and Aging, University Centre of Sports Medicine, University "G. d'Annunzio, Viale Abruzzo 322, Chieti, Italy.
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, Università Di Firenze, Largo Brambilla 3, 50100, Florence, Italy
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17
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Li W, Hou M, Ding Z, Liu X, Shao Y, Li X. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:686983. [PMID: 34630275 PMCID: PMC8497704 DOI: 10.3389/fneur.2021.686983] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Stroke has become a major problem around the world, which is one of the main causes of long-term disability. Therefore, it is important to seek a biomarker to predict the prognosis of patients with stroke. This meta-analysis aims to clarify the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the prognosis of stroke patients. Methods: This study was pre-registered in PROSPERO (CRD42020186544). We performed systematic research in PubMed, Web of Science, and EMBASE databases for studies investigating the prognostic value of NLR. Based on the enrolled studies, patients were divided into the low-NLR cohort and the high-NLR cohort. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted and analyzed by the Review Manager 5.3 and Stata 12.0 software. Heterogeneity was estimated by using Cochran's Q test and I2 value. Sensitivity analyses and subgroup analyses were also performed to explore the potential sources of heterogeneity. Publication bias was assessed with funnel plots and assessed by Egger's tests. Results: Forty-one studies with 27,124 patients were included. In the overall analysis, elevated NLR was associated with an increased mortality in acute ischemic stroke (AIS) patients (OR = 1.12, 95% CI = 1.07–1.16) and in acute hemorrhagic stroke (AHS) patients (OR = 1.23, 95% CI = 1.09–1.39), poorer outcomes in AIS patients (OR = 1.29, 95% CI = 1.16–1.44), and in AHS patients (OR = 1.11, 95% CI = 1.03–1.20). While in terms of hemorrhagic transformation (HT), elevated NLR was associated with an increased incidence of HT in AIS patients (OR = 1.15, 95% CI = 1.08–1.23). Conclusions: This study demonstrated that elevated NLR was significantly associated with poor prognosis of stroke patients. High NLR is associated with a 1.1- to 1.3-fold increased risk of poor outcomes of AIS/AHS patients. NLR could be helpful as a potential prognostic biomarker to guide clinical decision making. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186544.
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Affiliation(s)
- Wenxia Li
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Miaomiao Hou
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhibin Ding
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaolei Liu
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuan Shao
- Shanxi Medical University, Taiyuan, China
| | - Xinyi Li
- Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.,Shanxi Medical University, Taiyuan, China
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18
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Quan K, Wang A, Zhang X, Meng X, Chen P, Li H, Wang Y. Neutrophil to lymphocyte ratio and adverse clinical outcomes in patients with ischemic stroke. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1047. [PMID: 34422959 PMCID: PMC8339844 DOI: 10.21037/atm-21-710] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/11/2021] [Indexed: 01/05/2023]
Abstract
Background Neutrophils and lymphocytes mediate differential inflammatory responses after ischemic stroke and have different effects on patients’ clinical outcomes. Several studies have used the neutrophil to lymphocyte ratio (NLR) as a prognostic indicator for ischemic stroke; however, some limitations remain. Methods We derived data from the Third China National Stroke Registry. The NLR is defined as neutrophil count/lymphocyte count. Patients included in the study were classified into four groups by NLR quartiles. Odds ratios (ORs) of adverse clinical outcomes were calculated with the lowest quartile group as the reference category. We plotted receiver operating characteristic (ROC) curves of NLR for adverse clinical outcomes and calculated area under the curve (AUC) values and cutoff values. Under different TOAST classifications, medians of NLR and ORs of adverse clinical outcomes were also calculated. Furthermore, interaction tests between NLR and etiology were performed. Results A total of 13,018 patients were enrolled. At both 3- and 12-month follow-ups, higher quartile groups were associated with increased risks of death and poor functional outcomes, even after adjustments. For death, the cutoff values of NLR were 3.872 at 3-month follow-up and 3.180 at 12-month follow-up. For poor functional outcomes, the cutoff value of NLR was 2.846 at both 3- and 12-month follow-ups. The association between NLR and stroke recurrence was significant only at 3-month follow-up before adjustments. There was no correlation between NLR and hemorrhagic transformation during hospitalization. Under different TOAST classifications, the medians of NLR were different; conversely, the correlations of NLR with adverse clinical outcomes had no differences. Conclusions High level of NLR within the first 24 h after admission was associated with increased risks of both short- and long-term adverse clinical outcomes in patients with ischemic stroke, regardless of etiology.
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Affiliation(s)
- Kehua Quan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pan Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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19
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Nguyen VA, Crewther SG, Howells DW, Wijeratne T, Ma H, Hankey GJ, Davis S, Donnan GA, Carey LM. Acute Routine Leukocyte and Neutrophil Counts Are Predictive of Poststroke Recovery at 3 and 12 Months Poststroke: An Exploratory Study. Neurorehabil Neural Repair 2021; 34:844-855. [PMID: 32940147 DOI: 10.1177/1545968320948607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Aims. White blood cell (WBC) and neutrophil counts (NC) are common markers of inflammation and neurological stroke damage and could be expected to predict poststroke outcomes. Objective. The aim of this study was to explore the prognostic value of early poststroke WBC and NC to predict cognition, mood, and disability outcomes at 3 and 12 months poststroke. Methods. Routine clinical analyses WBC and NC were collected at 3 time points in the first 4 days of hospitalization from 156 acute stroke patients. Correlations using hierarchical or ordinal regressions were explored between acute WBC and NC and functional recovery, depression, and cognition at 3 and 12 months poststroke, after covarying for age and baseline stroke severity. Results. We found significant increases in NC between <12 hours and 24 to 48 hours time points (P = .05). Hierarchical regressions, covaried for age and baseline stroke severity, found that 24 to 48 hours WBC (P = .05) and NC (P = .04) significantly predicted 3-month cognition scores. Similarly, 24 to 48 hours WBC (P = .05) and NC (P = .02) predicted cognition scores at 12 months. Increases in WBC and NC were predictive of increased cognition scores at both 3 and 12 months (positive recovery) though there were no significant associations between WBC and NC and disability or depression scores. Conclusions. Routine acute stroke clinical laboratory tests such as WBC and NC taken between 24 and 48 hours poststroke are predictive of cognition poststroke. It is interpreted that higher rapid immunological activation in the acute phase is an indicator for the trajectory of positive stroke recovery.
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Affiliation(s)
- Vinh A Nguyen
- La Trobe University, College of Science, Health and Engineering, Bundoora, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Sheila G Crewther
- La Trobe University, College of Science, Health and Engineering, Bundoora, Victoria, Australia
| | | | - Tissa Wijeratne
- Melbourne Medical School, Western Health, Sunshine Hospital, St Albans, Victoria, Australia
| | - Henry Ma
- Department of Medcine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Graeme J Hankey
- University of Western Australia, Perth, Western Australia, Australia
| | - Stephen Davis
- Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Parkville, Victoria, Australia
| | - Leeanne M Carey
- La Trobe University, College of Science, Health and Engineering, Bundoora, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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20
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Muñoz-Delgado L, Macías-García D, Jesús S, Martín-Rodríguez JF, Labrador-Espinosa MÁ, Jiménez-Jaraba MV, Adarmes-Gómez A, Carrillo F, Mir P. Peripheral Immune Profile and Neutrophil-to-Lymphocyte Ratio in Parkinson's Disease. Mov Disord 2021; 36:2426-2430. [PMID: 34101890 DOI: 10.1002/mds.28685] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) in peripheral blood is a well-established inflammatory marker, but its role in Parkinson's disease (PD) remains unclear. OBJECTIVES To determine whether a different peripheral immune profile and NLR were present in PD patients. METHODS We conducted a case-control study that included 377 PD patients and 355 healthy controls (HCs). Leukocytes, subpopulations, and the NLR were measured. Multivariate linear regression analyses were applied to determine the differences between groups and the association between NLR and clinical characteristics in PD. A meta-analysis was performed to clarify the association between NLR and PD. RESULTS In our case-control study, the NLR was significantly higher in PD patients compared with HCs (2.47 ± 1.1 vs. 1.98 ± 0.91, P < 0.001). No association between NLR and age at onset, disease severity, or disease duration was found. The meta-analysis showed that the NLR was likely to be higher in PD patients. CONCLUSIONS PD patients had an altered peripheral immune profile and a higher NLR compared with HCs. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Laura Muñoz-Delgado
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Daniel Macías-García
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Francisco Martín-Rodríguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Seville, Spain
| | - Miguel Ángel Labrador-Espinosa
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | - María Valle Jiménez-Jaraba
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Astrid Adarmes-Gómez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Fátima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
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21
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Weng Y, Zeng T, Huang H, Ren J, Wang J, Yang C, Pan W, Hu J, Sun F, Zhou X, Qiu H, Gao Y, Gao B, Chi L, Chen G. Systemic Immune-Inflammation Index Predicts 3-Month Functional Outcome in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis. Clin Interv Aging 2021; 16:877-886. [PMID: 34040364 PMCID: PMC8143961 DOI: 10.2147/cia.s311047] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
Background and Purpose Systemic immune-inflammation index (SII), a novel inflammation index derived from counts of circulating platelets, neutrophils and lymphocytes, has been studied in developing incident cancer. However, the clinical value of SII in acute ischemic stroke (AIS) patients had not been further investigated. Therefore, we aimed to explore the association between SII and severity of stroke as well as 3-month outcome of AIS patients. Methods A total of 216 AIS patients receiving intravenous thrombolysis (IVT) and 875 healthy controls (HCs) were retrospectively recruited. Blood samples were collected within 24h after admission. Severity of stroke was assessed by the National Institute of Health stroke scale (NIHSS) scores on admission and poor 3-month functional outcome was defined as Modified Rankin Scale (mRS) > 2. Results SII levels in AIS patients were higher than in HCs. The cut-off value of SII is 545.14×109/L. Patients with SII > 545.14×109/L had higher NIHSS scores (median: 5 vs 9, p < 0.001), a positive correlation between SII and NIHSS was observed (rs = 0.305, p < 0.001). Multivariate logistic regression analyses showed that high SII was one of the independent risk factors for poor prognosis at 3 months of AIS patients (OR = 3.953, 95% CI = 1.702-9.179, p = 0.001). The addition of SII to the conventional prognostic model improved the reclassification (but not discrimination) of the functional outcome (net reclassification index 39.3%, p = 0.007). Conclusion SII is correlated with stroke severity at admission and can be a novel prognostic biomarker for AIS patients treated with IVT.
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Affiliation(s)
- Yiyun Weng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Tian Zeng
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Honghao Huang
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Junli Ren
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jianing Wang
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Chenguang Yang
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wenjing Pan
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jingyu Hu
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Fangyue Sun
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xinbo Zhou
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Haojie Qiu
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yufan Gao
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China.,Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Beibei Gao
- Department of Internal Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Lifen Chi
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Guangyong Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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22
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Piri Cinar B, Kunt R, Yuksel B, Gulluoglu H, Sayilir I, Celiker Uslu S, Ozaydin Goksu E, Bülbül NG, Yildiz B, Oz D, Keskin AO, Korucu O, Akpinar K, Solmaz V, Akpinar M, Altunc FZ, Elmas Z, Acikgoz B. Assessment of the relation between the neutrophil to lymphocyte ratio and severity of ischemic stroke in a large cohort. Int J Clin Pract 2021; 75:e13955. [PMID: 33342005 DOI: 10.1111/ijcp.13955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022] Open
Abstract
AIM OF STUDY The NLR is a simple and inexpensive parameter that is useful as a marker of subclinical inflammation. The purpose of this study was to investigate the clinical characteristics of patients diagnosed with acute cerebral ischemia at the time of initial evaluation in the emergency department. PATIENTS AND METHODS The study was designed as a multicentre cross-sectional study of acute ischemic stroke patients. Neurological evaluations were assessed using the NIHSS and mRS. Evaluations included the results of patients' laboratory tests performed at the time of presentation to the emergency department. RESULTS Seven hundred and thirty-five ischemic stroke patients were included in the study. Stroke cases assessed by the mRS as mild or severe showed significant differences with respect to age, leukocyte counts, neutrophil counts, NLR, LDL cholesterol values, and serum glucose values (P = .001). When analysed using NIHSS, lymphocyte levels were significantly higher in very severe stroke cases compared with mild, moderate, and severe cases. NLR was also significantly higher in very severe stroke cases and severe stroke cases as compared with the mild and moderate stroke groups. Neurological evaluations assessed using the mRS showed a mild positive correlation with neutrophil and leukocyte count and a weak correlation with the NLR. CONCLUSION The NLR exhibited a significant correlation with the results of the mRS and NIHSS. The NLR measured in the very early period was also significantly associated with clinical condition. These results suggest that high NLR values may be a marker of stroke' severity.What's known Stroke is an important disease that has a significant impact on mortality and morbidity and is closely related to the aging world population. In recent years, highly innovative approaches have been developed in the treatment of stroke. Although a long distance has been covered in the early diagnosis of stroke, the ability to predict the severity of the disease with many parameters is still up to date. What's new At the time of admission, in the absence of infection, parameters such as leukocytelymphocyte count and NLR may be telling about stroke severity. Demonstrating the utility of these simple, practical, inexpensive and naninvasive parameters to predict stroke severity can contribute to the scoring to be established at the time of initial diagnosis.
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Affiliation(s)
- Bilge Piri Cinar
- Department of Neurology, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Refik Kunt
- Department of Neurology, Aydin State Hospital, Aydin, Turkey
| | - Burcu Yuksel
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Halil Gulluoglu
- Department of Neurology, Medical Park İzmir Hospital, Izmir, Turkey
| | - Idris Sayilir
- Department of Neurology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Sibel Celiker Uslu
- Department of Neurology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Eylem Ozaydin Goksu
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Baykal Yildiz
- Department of Neurology, Dr Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Didem Oz
- Department of Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ahmet Onur Keskin
- Department of Neurology, Eskisehir Yunus Emre State Hospital, Eskisehir, Turkey
| | - Osman Korucu
- Department of Neurology, Keciören Training and Research Hospital, Ankara, Turkey
| | - Kursad Akpinar
- Department of Neurology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Volkan Solmaz
- Department of Neurology, Istanbul Acibadem Hospital, Istanbul, Turkey
| | - Meliha Akpinar
- Department of Neurology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Fatma Zehra Altunc
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Zeynep Elmas
- Department of Neurology, Medical Park İzmir Hospital, Izmir, Turkey
| | - Bilgehan Acikgoz
- Department of Public Health, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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23
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Cavrak ME, Hass R, Stephens RJ, Adcock A, Petrone AB. Leukocyte Biomarkers for the Differential Diagnosis of Mild Acute Ischemic Stroke, Transient Ischemic Attack, and Stroke Mimic. Cureus 2021; 13:e13383. [PMID: 33754106 PMCID: PMC7972806 DOI: 10.7759/cureus.13383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The differential diagnosis of transient ischemic attack (TIA) versus mild acute ischemic stroke (AIS) during the initial presentation to the emergency department is often difficult, as the diagnosis of both TIA and AIS relies on the presence of focal neurologic signs. As such, roughly 50% of patients with transient or mild neurologic deficits have an uncertain diagnosis prior to neuroimaging. Biomarkers, particularly leukocyte biomarkers, may be used by clinicians to diagnose mild AIS prior to neuroimaging, and this study is the first to describe the use of leukocyte biomarkers for the differentiation of mild AIS, TIA, and stroke mimic. Methods We performed a retrospective chart review of patients discharged from a local hospital with a discharge diagnosis of either TIA or AIS. Past medical history and complete blood cell count with differential upon admission were collected for all subjects. Statistical analyses were performed to compare immune cell parameters between the two groups. For all comparisons, logistic regression analysis was used to assess the effect of confounding variables, such as age, gender, and medical history for each study variable. Results Of all the immune parameters assessed in this study, the neutrophil percentage was the only significant biomarker that significantly differed between study groups. After adjustment for confounding variables using stepwise logistic regression, mild AIS patients were 5.3 times more likely than TIA cases to have a neutrophil percentage above the normal range. Conclusion Our results suggest that clinicians may utilize neutrophil percentage as an additional piece of information that may aid in their diagnosis of mild AIS versus TIA.
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Affiliation(s)
- Megan E Cavrak
- Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Rotem Hass
- Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Ronald J Stephens
- Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Amelia Adcock
- Neurology, West Virginia University School of Medicine, Morgantown, USA
| | - Ashley B Petrone
- Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, USA
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24
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Ding KQ, Lai ZH, Zhang Y, Yang GY, He JR, Zeng LL. Monocyte-to-Lymphocyte Ratio is Associated with Depression 3 Months After Stroke. Neuropsychiatr Dis Treat 2021; 17:835-845. [PMID: 33776439 PMCID: PMC7989958 DOI: 10.2147/ndt.s299462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To explore the relationship between the monocyte-to-lymphocyte ratio (MLR) and depression three months after acute ischemic stroke. PATIENTS AND METHODS From May 2013 to September 2014, 203 patients with acute ischemic stroke were recruited within 7 days post-stroke from Shanghai Ruijin Hospital and blood samples were collected after admission. The Hamilton Depression Scale and Clinical Review were evaluated at 3 months after stroke. Based on the Diagnostic and Statistical Manual of Mental Disorders-IV diagnostic criteria, we divided patients into post-stroke depression (PSD) and non-PSD groups. We analyzed the intergroup difference in MLR and the contributing factors. Moreover, dynamic changes in monocytes, lymphocytes and MLR at four different time intervals for all the stroke patients and their relationship with PSD patients were also studied. RESULTS The NIHSS scores and MLR in the PSD group were significantly higher than in the non-PSD group (p<0.05). Logistic regression analysis revealed MLR was an independent risk factor for PSD (odds ratio: 18.020, 95% confidence interval: 1.127‒288.195, p=0.041). MLR correlated negatively with cholesterol and low-density lipoprotein (r=-0.160 and -0.165, respectively, p<0.05). Within 7 days post-acute ischemic stroke, monocytes gradually increased while lymphocytes remained unchanged for all the stroke patients. The MLR value was significantly higher in the PSD group than in the non-PSD group within 24 h post-stroke (p<0.05), but there was no difference in the other three time-intervals between the two groups. CONCLUSION The admission MLR, particularly within 24 h post-stroke, was associated with PSD at 3 months, implying that the MLR might be involved in the PSD inflammatory mechanism.
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Affiliation(s)
- Kai-Qi Ding
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ze-Hua Lai
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yu Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Guo-Yuan Yang
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ji-Rong He
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Li-Li Zeng
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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25
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Wang L, Guo W, Wang C, Yang X, Hao Z, Wu S, Zhang S, Wu B, Liu M. Dynamic Change of Neutrophil to Lymphocyte Ratios and Infection in Patients with Acute Ischemic Stroke. Curr Neurovasc Res 2020; 17:294-303. [PMID: 32268864 DOI: 10.2174/1567202617666200408091131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
Background:
Neutrophil to lymphocyte ratio (NLR) on admission was reported to be a
predictor of pneumonia after stroke. The aim of this study was to investigate the association between
the temporal change of NLR and post-stroke infection and whether infection modified the
effect of NLR on the outcome.
Methods:
We enrolled patients with acute ischemic stroke within 24 h after onset. The blood was
collected on admission, day 1, 3, 7 after admission to detect white blood cells (WBC), neutrophils,
and lymphocytes. Primary outcomes included pneumonia, urinary tract infection (UTI), other infection,
and the secondary outcome was 3-month death.
Results:
Of 798 stroke patients, 299 (37.66%) developed infection with 240 (30.23%) pneumonia,
78 (9.82%) UTI, and 9 (1.13%) other infection. The median time of infection occurrence was 48 h
(interquartile range 27-74 h) after onset. NLR reached to the peak at 36 h. For all outcomes, NLR
at 36 h after stroke had the highest predictive value than WBC, neutrophil, lymphocyte. NLR was
independently associated with the presence of any infection (odds ratio [OR] 1.11, 95% confidence
interval [CI] 1.05-1.17), pneumonia (OR 1.12, 95%CI 1.05-1.19), but not UTI (OR 0.95, 95%CI
0.89-1.01). Adding infection or the interaction term did not substantially change the OR of NLR
predicting 3-month death (OR 1.09, 95%CI 1.01, 1.17).
Conclusion:
Increased NLR around 36 h after stroke was a predictor of infection in patients with
acute ischemic stroke. The increased NLR value was associated with a higher risk of 3-month
death, which was independent of poststroke infection.
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Affiliation(s)
- Lu Wang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Wen Guo
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Changyi Wang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Xue Yang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Zilong Hao
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Simiao Wu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Shihong Zhang
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Bo Wu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
| | - Ming Liu
- Department of Neurology, Sichuan University, West China Hospital, Sichuan, China
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26
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Ye WY, Li J, Li X, Yang XZ, Weng YY, Xiang WW, Zhang O, Ke BX, Zhang X. Predicting the One-Year Prognosis and Mortality of Patients with Acute Ischemic Stroke Using Red Blood Cell Distribution Width Before Intravenous Thrombolysis. Clin Interv Aging 2020; 15:255-263. [PMID: 32110004 PMCID: PMC7039056 DOI: 10.2147/cia.s233701] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose Red blood cell (RBC) distribution width (RDW) is known to reflect the heterogeneity of RBC volume, which may be associated with cardiovascular events or mortality after myocardial infarction. However, the association between RDW and stroke, especially regarding endpoints such as death, remains ambiguous. This study aimed to explore the prognostic value of RDW and its effect on mortality among patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT) after one year. Patients and Methods We retrospectively reviewed patients with AIS treated with IVT between January 2016 and March 2018. We grouped the patients according to modified ranking scale (MRS) scores as follows:0–2, favorable functional outcome group; and 3–6, unfavorable functional outcome. Predictors were determined using multivariate logistic regression (MVLR). The area under receiver-operating characteristic curve (AUC) was used to evaluate the predictive capability of variables. Furthermore, the Cox proportional hazard model was used to assess the contribution of risk factors to the outcome of death at one year later. Results MVLR analysis showed that RDW (odds ratio [OR], 1.179; 95% confidence interval [CI], 0.900–1.545; p = 0.232) was not an independent predictor of unfavorable functional outcome, but it (OR 1.371; 95% CI 1.109–1.696; p = 0.004) was an independent biomarker for all-cause mortality. The optimal RDW cut-off value to predict mortality was 14.65% (sensitivity: 42%, specificity: 88.3%, AUC: 0.649, p < 0.001). Furthermore, higher RDW (hazard ratio, 2.860; 95% CI, 1.724–4.745; p < 0.001) indicated a greater risk of death. Conclusion The baseline RDW is a potential predictor of mortality in patients with AIS undergoing IVT, but RDW might not be associated with worse survival function among stroke survivors, which will help us to improve treatments and the management of patients with AIS.
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Affiliation(s)
- Wei-Yi Ye
- Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jia Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiang Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xue-Zhi Yang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yi-Yun Weng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wei-Wei Xiang
- School of Mental Health, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ou Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Bo-Xi Ke
- Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, People's Republic of China
| | - Xu Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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27
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Dong X, Nao J, Shi J, Zheng D. Predictive Value of Routine Peripheral Blood Biomarkers in Alzheimer's Disease. Front Aging Neurosci 2019; 11:332. [PMID: 31866854 PMCID: PMC6906180 DOI: 10.3389/fnagi.2019.00332] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background Biomarker screening is of major significance for the early diagnosis and prevention of Alzheimer’s disease (AD). Routine peripheral blood parameters are easy to collect and detect, making them ideal potential biomarkers. Thus, we aimed to evaluate the parameters from routine blood as potential biomarkers for AD. Methods We enrolled 56 AD patients, 57 mild cognitive impairment (MCI) patients, and 59 healthy elderly controls. Receiver operating characteristic (ROC) curves were used to assess the diagnostic values of routine blood biomarkers in patients with cognitive impairment. Results There were significant differences in eight parameters between the groups. Logistic regression revealed that the neutrophil% (odds ratio (OR) 1.34, 95% confidence interval [CI] 1.03–1.75, p = 0.031) and neutrophil-to-lymphocyte ratio (NLR; OR 6.27, 95% CI 3.98–9.82, p = 0.003) differentiated AD patients and controls (areas under the curve [AUCs], 0.728 and 0.721) and that the NLR (OR 1.93, 95% CI 1.07–3.47, p = 0.028) and mean platelet volume (OR 1.67, 95% CI 1.04–2.70, p = 0.036) differentiated MCI patients and controls (AUCs, 0.60 and 0.638). There were no effective diagnostic biomarkers to distinguish AD from MCI. Conclusion Some routine blood biomarkers may correlate with cognitive impairment. Analysis of these biomarkers, such as the NLR, may be useful for the identification of patients with cognitive impairment.
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Affiliation(s)
- Xiaoyu Dong
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianfei Nao
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jile Shi
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dongming Zheng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
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28
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Wang L, Song Q, Wang C, Wu S, Deng L, Li Y, Zheng L, Liu M. Neutrophil to lymphocyte ratio predicts poor outcomes after acute ischemic stroke: A cohort study and systematic review. J Neurol Sci 2019; 406:116445. [PMID: 31521961 DOI: 10.1016/j.jns.2019.116445] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/23/2019] [Accepted: 08/30/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The relationship between neutrophil to lymphocyte ratio (NLR) and prognosis after acute ischemic stroke (AIS) remains controversial. The aim of this cohort study and systematic review was to ascertain the association of admission NLR with major clinical poor outcomes after AIS. METHODS We analyzed data from Chengdu stroke registry and performed a systematic review for previous literature. The outcomes were hemorrhagic transformation (HT), parenchymal hematoma (PH), symptomatic intracranial hemorrhage (sICH), 3-month death or disability (modified Rankin Scale≥3), and 3-month death. Odds ratios (ORs) and 95% confidence intervals (CIs) of NLR as a continuous and categorical variable and poor outcomes were pooled separately. We also calculated the predictive accuracy of admission NLR in different outcomes. RESULTS We included 808 patients from registry database and 9563 patients from previous studies. Our registry data showed that NLR ≥5 was associated with HT (OR 2.03, 95%CI 1.19-3.46), PH (OR 2.54, 95%CI 1.20-5.35) and 3-month death (OR 5.55, 95%CI 1.41-21.89); meta-analysis with our data and other observational studies indicated that higher NLR was associated with HT (OR 1.99, 95% CI 1.45-2.73), sICH (OR 2.22, 95% CI 1.60-3.09), 3-month death or disability (OR 1.68, 95% CI 1.18-2.38), and 3-month death (OR 2.79, 95% CI 1.57, 4.94). NLR had the highest predictive accuracy for 3-month death. CONCLUSIONS Higher NLR is positively associated with the risk of HT and 3-month death after stroke. Considering the limited predictive ability of a single biomarker, more studies should validate the role of NLR in prognostic models.
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Affiliation(s)
- Lu Wang
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Quhong Song
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Changyi Wang
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Simiao Wu
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Deng
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxiao Li
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lukai Zheng
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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