High neutrophil-to-lymphocyte ratio is associated with poor clinical outcome in patients with critically ill stroke

BACKGROUND: This study aimed to evaluate the relationship between inflammatory markers on admission and clinical outcome in patients with critically ill stroke. METHODS: We retrospectively extracted data from our prospectively organized database of consecutive adult patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) admitted to our neurocritical care unit (NCU) within 72 hours of the onset between Jan 2013 and Dec 2017. From white blood cell (WBC) counts, levels of C-reactive protein (CRP) and albumin obtained on admission, we calculated neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein-to-albumin ratio (CAR). Clinical outcomes included 30-day mortality and 90-day poor outcome (mRS of 4-6). RESULTS : A total of 387 patients were included. Of them, 242 (62.5%) patients were AIS, 51 (13.2%) died within 30 days and 149 (38.5%) suffered poor outcome at 90 days. NLR, LMR and CAR, but not PLR, were associated with increased odds of 30-day mortality and 90-day poor outcome in univariable analysis, whereas only high NLR (NLR >= 5.87; adjusted odds ratio 2.079; 95% confidence interval 1.232-3.506; P=0.006) remained significant after adjusting for confounders in multivariable analysis of 90-day poor outcome. CONCLUSIONS: Inflammatory markers like NLR, LMR and CAR on admission were associated with increased risks of 30-day mortality and 90-day poor outcome in patients with critically ill stroke. Especially, high NLR is independently associated with 90-day poor outcome.