The Monocyte-to-HDL ratio (MHR) as a prognostic and diagnostic biomarker in Acute Ischemic Stroke: A systematic review with meta-analysis
Gerardo Luna-Peralta1, Jeancarlo Ney Velazco-Muñoz1, Wagner Rios-Garcia2, Fritz Fidel Váscones-Román3, Ivan Alegre1, Gianfranco Carbajal-García1, Carlos Quispe-Vicuña4
1Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú, 2Universidad Nacional San Luis Gonzaga, Ica, Perú, 3Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú, 4Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima, Perú
Objective:
To summarize the current evidence on the diagnostic and prognostic value of Monocyte-to-HDL ratio (MHR) on acute ischemic stroke (AIS)
Background:
Recently, the MHR has been studied as a potential biomarker for assessing the prognosis of different diseases.
Design/Methods:
We searched 5 databases (PubMed, Embase, Scopus, Web of Science and Google Scholar) until June 2024. We included observational studies that evaluated the association between MHR and AIS. A meta-analysis using a random-effects model to estimate pooled effects was planned for each outcome and a narrative synthesis when this was not possible. The Newcastle-Ottawa scale was used to assess the risk of bias and GRADE criteria were used to identify the certainty of evidence.
Results:
11 studies (7 cohorts, 3 cross-sectionals and 1 case-control) were included. With high uncertainty, a meta-analysis of 4 studies showed a significantly increased risk of AIS in patients with a higher MHR (MD: 2.14, 95%CI: 1.75 to 2.54, I2: 100%, 4 studies). Regarding AIS prognosis, two separate meta-analysis were conducted on 30-day mortality and functional outcome. With high uncertainty, the MHR was found to be higher in deceased patients within 30 days of AIS onset (MD: 3.22, 95%CI: -3.28 to 9.72, I2: 99%, 2 studies), and higher in patients with mRS score >2 at 90 days (MD: 0.15, 95%CI: -0.05 to 0.34, I2: 87%, 2 studies). Additionally, all studies reported a low risk of bias.
Conclusions:
With high uncertainty, we found that MHR is a useful tool for the diagnosis and prediction of poor outcomes in AIS. However, we need more studies, especially prospective ones, in order to improve the evidence regarding this index.
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