Temporal changes in the neutrophil to lymphocyte ratio and the neurological progression in cryptogenic stroke with active cancer
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...
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| Published in | PloS one Vol. 13; no. 3; p. e0194286 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
16.03.2018
Public Library of Science (PLoS) |
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| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0194286 |
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| Abstract | 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. |
|---|---|
| AbstractList | 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. Background 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. Aim We aimed to evaluate the association between the NLR and END in cancer-related stroke patients. Methods 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). Results 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. Conclusions 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. Background 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. Aim We aimed to evaluate the association between the NLR and END in cancer-related stroke patients. Methods 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). Results 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. Conclusions 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. 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.BACKGROUNDIschemic 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.AIMWe 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).METHODSWe 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.RESULTSEND 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.CONCLUSIONSThis 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. 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. |
| Author | Kang, Min Kyoung Kim, Tae Jung Mo, Heejung Han, Moon-Ku Jeong, Han-Yeong Nam, Ki-Woong Ko, Sang-Bae Yoon, Byung-Woo Kim, Chi Kyung |
| AuthorAffiliation | 4 Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea 3 Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, Seoul, Korea 1 Department of Neurology, Seoul National University College of Medicine, Seoul, Korea 2 Department of Neurology, Seoul National University Hospital, Seoul, Korea Massachusetts General Hospital, UNITED STATES |
| AuthorAffiliation_xml | – name: 2 Department of Neurology, Seoul National University Hospital, Seoul, Korea – name: 4 Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea – name: Massachusetts General Hospital, UNITED STATES – name: 3 Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, Seoul, Korea – name: 1 Department of Neurology, Seoul National University College of Medicine, Seoul, Korea |
| Author_xml | – sequence: 1 givenname: Ki-Woong orcidid: 0000-0001-7514-6264 surname: Nam fullname: Nam, Ki-Woong – sequence: 2 givenname: Tae Jung surname: Kim fullname: Kim, Tae Jung – sequence: 3 givenname: Chi Kyung surname: Kim fullname: Kim, Chi Kyung – sequence: 4 givenname: Heejung surname: Mo fullname: Mo, Heejung – sequence: 5 givenname: Han-Yeong surname: Jeong fullname: Jeong, Han-Yeong – sequence: 6 givenname: Min Kyoung surname: Kang fullname: Kang, Min Kyoung – sequence: 7 givenname: Moon-Ku surname: Han fullname: Han, Moon-Ku – sequence: 8 givenname: Sang-Bae surname: Ko fullname: Ko, Sang-Bae – sequence: 9 givenname: Byung-Woo surname: Yoon fullname: Yoon, Byung-Woo |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29547637$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1111_jth_15779 crossref_primary_10_2147_JIR_S493406 crossref_primary_10_3390_su13074069 crossref_primary_10_1016_j_jstrokecerebrovasdis_2022_106604 crossref_primary_10_1038_s41598_021_97154_1 crossref_primary_10_1055_s_0043_1771270 crossref_primary_10_18700_jnc_230031 crossref_primary_10_3389_fneur_2019_01032 crossref_primary_10_3389_fneur_2022_1032984 |
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| Copyright | 2018 Nam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2018 Nam et al 2018 Nam et al |
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| Snippet | Ischemic stroke patients with active cancer frequently experience early neurological deterioration (END); however, the predictors of END are not well studied.... Background Ischemic stroke patients with active cancer frequently experience early neurological deterioration (END); however, the predictors of END are not... Background Ischemic stroke patients with active cancer frequently experience early neurological deterioration (END); however, the predictors of END are not... |
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| SubjectTerms | 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 |
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| Title | Temporal changes in the neutrophil to lymphocyte ratio and the neurological progression in cryptogenic stroke with active cancer |
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