Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Stroke: A Systematic Review and Meta-Analysis

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 I-2 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.

Automated summary

This meta-analysis found that elevated neutrophil-to-lymphocyte ratio (NLR) is significantly associated with poor prognosis of stroke patients, with a 1.1- to 1.3-fold increased risk of poor outcomes in acute ischemic stroke (AIS) and acute hemorrhagic stroke (AHS) patients. Additionally, elevated NLR is also linked to an increased incidence of hemorrhagic transformation (HT) in AIS patients. This suggests NLR could serve as a potential prognostic biomarker for guiding clinical decision making in stroke patients.