NLR、MLR And PLR Combined With A~2DS~2 In The Prediction Of Stroke-associated Pneumonia

Objective:In this study,we analyzed the risk factors of stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS)and explored the Neutrophil-to-Lymphocyte Ratio(NLR),Monocyte-to-Lymphocyte Ratio(MLR),Platelet-to-Lymphocyte Ratio(PLR)combined with A~2DS~2 can improve the prediction ability of SAP occurrence,provide a scientific basis for the prevention of SAP occurrence,and improve the prognosis of AIS patients.Methods:We enrolled AIS patients who were hospitalized in neurology department of a Shanghai sixth people’s hospital from January 2018 to August 2018,and collected their baseline data and laboratory data.All patients were divided into the SAP group and non-SAP group according to whether they had SAP.The risk factors of SAP were analyzed by univariate analysis and logistic regression.The predictive value of NLR,MLR and PLR to sap was analyzed by the receiver operating characteristic curve.According to the cut-off value,the A~2DS~2 is assigned to generate a new joint score:NLR-A~2DS~2,MLR-A~2DS~2,PLR-A~2DS~2 and total score-A~2DS~2.Using Med Calc 15.2.2 software to compare whether the improved A~2DS~2scoring model is better than the traditional A~2DS~2 model.Results:1.489 AIS patients were included in this study.NLR、MLR and PLR were positively correlated with the volume of cerebral infarction and the severity of stroke.2.In 489 patients,70 patients in group SAP,419 in non SAP group,incidence rate of SAP was 14%.Through univariate analysis,we found that there were significant differences between SAP group and non SAP group in gender、age、NIHSS score、dysphagia、cerebral infarction volume、atrial fibrillation、diastolic pressure、glucose、neutrophil count、lymphocyte count、monocyte count、NLR、MLP and PLR(P<0.05).3.Multivariate analysis showed that age、NIHSS score、dysphagia、neutrophil count and MLR were independent risk factors for SAP.4.The prediction ability of NLR,MLR and PLR to sap is calculated by ROC curve,in which AUC of NLR is 0.737,AUC of MLR is 0.740,AUC of PLR is 0.671.5.AUC of traditional A~2DS~2 is 0.882,AUC of NLR-A~2DS~2 is 0.901,AUC of MLR-A~2DS~2 is 0.886,AUC of PLR-A~2DS~2 is 0.892,AUC of total score-A~2DS~2 is 0.901.Compared with the traditional A~2DS~2 scoring model,NLR-A~2DS~2 has a significant difference(P=0.02),while MLR-A~2DS~2 PLR-A~2DS~2 and total score-A~2DS~2 have no significant difference.To sum up,NLR-A~2DS~2 scoring model has better predictive value for SAP.Conclusions:1.Higher NLR,MLR and PLR may be related to larger cerebral infarction volume and more serious neurological deficit.2.Age、NIHSS score、dysphagia、neutrophil count and MLR were independent risk factors of SAP.3.NLR、MLR and PLR can be used as predictors of SAP occurrence.4.The NLR combined with A~2DS~2score,that is,the NLR-A~2DS~2 score model,has a higher predictive value for SAP than the traditional A~2DS~2 score model.