Baseline Neutrophil/Lymphocyte Ratio and Severity of Acute Stroke among Indigenous West Africans: Insights from the SIREN Multi-center Study
Oladotun Olalusi1, Oluwaseun Williams2, Reginald Obiako5, Morenikeji Komolafe6, Godwin Osaigbovo7, Godwin Ogbole3, Oyedunni Arulogun4, Carolyn Jenkins8, Fred Sarfo9, Kolawole Wahab10, Lukman Owolabi11, Joshua Akinyemi2, Albert Akpalu12, Rufus Akinyemi13, Bruce Ovbiagele14, Adesola Ogunniyi15, Mayowa Owolabi16
1Neurology, University College Hospital Ibadan, 2Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria., 3Radiology, 4Department of Health Promotion and Education, University of Ibadan, 5Medicine, Department of Medicine, Ahmadu Bello University & Ahmadu Bello university Teaching Hospital, Zaria, Kaduna state, 6Obafemi Awolowo University, 7Jos University Teaching Hospital, Jos, 8Nursing, Medical University of South Carolina, 9Medicine, Kwame Nkrumah University of Science and Technology, 10University of Ilorin Teaching Hospital, 11Bayero University, 12School of Medicine and Dentistry, 13Institute for Advanced Medical Research and Training, 14San Francisco VA, 15College of Medicine, University of Ibadan, 16Neurology Unit, Dept of Med, UCH
Objective:
We determined the relationship between neutrophil-lymphocyte ratio (NLR) and stroke severity
Background:
NLR is an important biomarker for risk stratification in acute stroke care, however, there is uncertainty regarding its applicability and translation into practice among Indigenous West Africans known to have benign neutropenia and severe stroke.
Design/Methods:
Stroke was confirmed using neuroimaging. Severe stroke was defined as NIHSS score>15 and Stroke levity Scale (SLS) score≤5, while NLR was obtained at admission. Stroke population was divided into tertiles and baseline clinical characteristics compared. Spearman correlation [Rho(ρ)] was used to test the relationship between NLR and stroke severity markers. A multivariate logistic regression model was constructed to determine the relationship between NLR and stroke severity. An ROC curve was used to identify NLR thresholds that best discriminated severe stroke
Results:
A total of 3684 controls and 3684 stroke cases were included [mean(SD)age 59.47(14.02), 52% males]. The median(IQR) NLR among study participants was: controls 0.8(0.5); cases 2.9(3.9) - ischemic stroke (IS) 2.4(3.1), intracerebral hemorrhage (ICH) 3.9(5.0), p<0.001. Of the stroke participants, 1248 (39.2%) and 1741 (49.7%) had severe stroke using NIHSS>15 and SLS≤5 respectively. There was a significant correlation between NLR and NIHSS score (ρ 0.29,p<0.001), NLR and SLS score (ρ -0.21,p<0.001). Baseline NLR [aOR,(95% CI)] was independently associated with severity of IS 1.06(1.03–1.08), but not ICH 1.00(0.99–1.01). NLR thresholds (sensitivity, specificity) of 3.0 (60.8%,61%) – overall; 3.98 (61.9%, 60.8%) – ICH; and 2.51 (60.2%,59.4%) – IS were observed to significantly discriminate participants with severe stroke, with an AUC (95% CI) of 0.65(0.62–0.67), 0.65(0.61–0.70), 0.63(0.60–0.66), respectively.
Conclusions:
We established an NLR threshold unique to West Africans and observed that baseline NLR is independently associated with severity of IS, but not ICH. Our findings emphasize the role of immune-inflammatory processes in IS pathobiology and may have implications for stroke care in settings with limited access to thrombolytic therapy.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.