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Dynamic Change of Neutrophil to Lymphocyte Ratios and Infection in Patients with Acute Ischemic Stroke

[ Vol. 17 , Issue. 3 ]

Author(s):

Lu Wang, Wen Guo, Changyi Wang, Xue Yang, Zilong Hao, Simiao Wu, Shihong Zhang, Bo Wu and Ming Liu*   Pages 294 - 303 ( 10 )

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.

Keywords:

Neutrophil to lymphocyte ratios, infection, pneumonia, prognosis, stroke, biomarkers.

Affiliation:

Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan, Department of Neurology, Sichuan University, West China Hospital, Sichuan



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