Temporal changes in the neutrophil to lymphocyte ratio and the neurological progression in cryptogenic stroke with active cancer

• Published in: PloS one Vol. 13; no. 3; p. e0194286
• Main Authors: Nam, Ki-Woong, Kim, Tae Jung, Kim, Chi Kyung, Mo, Heejung, Jeong, Han-Yeong, Kang, Min Kyoung, Han, Moon-Ku, Ko, Sang-Bae, Yoon, Byung-Woo
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.03.2018; Public Library of Science (PLoS)
• Subjects: Atherosclerosis; Biology and Life Sciences; Blood diseases; Cancer; Cancer therapies; Cell number; Cerebral infarction; Confidence intervals; Disease; Early experience; Hospitals; Infarction; Inflammation; Ischemia; Lymphocytes; Medicine; Medicine and Health Sciences; Metabolism; Metastasis; Multivariate analysis; Neurology; Neutrophils; Patients; Research and Analysis Methods; Risk factors; Stroke; Systematic review; Thrombosis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0194286

Ischemic stroke patients with active cancer frequently experience early neurological deterioration (END); however, the predictors of END are not well studied. The neutrophil to lymphocyte ratio (NLR) has recently been described as a predictor of poor outcomes in cancer and stroke. However, its role in cancer-related stroke has not been addressed. We aimed to evaluate the association between the NLR and END in cancer-related stroke patients. We included 85 cryptogenic stroke patients with active cancer. END was defined as an increase ≥ 4 on the total National Institutes of Health Stroke Scale (NIHSS) score within 72 hours of admission. The NLR was calculated as the ratio of the absolute neutrophil count to the absolute lymphocyte count. We obtained the NLR during the following three periods: at admission, 1-3 days after admission (D 1-3 NLR) and 4-7 days after admission (D 4-7 NLR). END occurred in 15 (18%) of the 85 patients. END was significantly associated with the initial NIHSS score, infarction volume, and the D 1-3 NLR. In multivariate analysis, a higher D 1-3 NLR, measured before END events, remained an independent predictor of END [adjusted odds ratio = 2.78, 95% confidence interval = 1.09-7.08, P = 0.032]. In terms of temporal changes in the NLR, the END group showed a tendency toward temporal increase in the NLR at D 1-3 (P = 0.061) with subsequent decrements in the D 4-7 NLR (P = 0.088), while the non-END group showed no significant changes in the NLR between periods. This study demonstrated that a higher NLR could predict END events in cryptogenic stroke patients with active cancer. However, the results should be confirmed in further large prospective studies.