Discussion On Clinical Application Value Of NLR In Patients With Acute Stroke

Objectives:The purpose of this study is to explore the association of neutrophil-to-Lymphocyte ratio(NLR)and the severity of stroke and early predictive values of NLR for stroke-associated pneumonia(SAP).Methods:The acute stroke patients who were clearly diagnosed and hospitalized in the Department of Neurology,the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 was included in the study.We collected these clinical datas for all subjects(including age,sex,stroke type,cerebrovascular risk factors,etc.),collected NIHSS indicating stroke severity,GCS for consciousness levels,blood parameters within 24 hours of admission(the total number of White blood cell,neutrophil,lymphatic,etc.).The NLR,hospital days,whether to die during hospital,whether to combine SAP and other relevant information were calculated in the study.According to the NIHSS of the subject at admitted to hospital,the patients were divided into mild stroke group(NIHSS<6),and medium-heavy stroke group(NIHSS ≥6).The baseline data of the patients in the two groups were compared,Spearman correlation analysis was adopted to analyze the correlation between NLR and the severity of stroke.Again according to the diagnostic criteria of stroke-associated pneumonia,these cases were divided into SAP group and non-SAP group,and the baseline data between 2 groups are compared,We analysis the correlation between NLR and SAP by using the binary classification logistic,and calculate the odds ratio(OR),95%confidence interval(CI)and analyze the independent correlation between NLR and stroke severity.Reusing the receiver operating characteristic curve(ROC)NLR was calculated in predicting in predicting Area under curve(AUC)and calculated NLR forecast cutoff value,sensitivity,and specificity of stroke.Results:1.The study finally included a total of 399 patients with acute stroke,aged 21-95 years old,with an average age of 63,9 years,including 55 patients of hemorrhagic stroke(13.8%),and ischemic stroke 344 cases(86.2%);252 cases were male(63.2%)and 147 cases were females(36.8%);283 cases in SAP group(70.9%)and 116 cases in non-SAP group(29.1%).2.Compared with the mild stroke group,patients in the stroke Medium-heavy group had more patients with COPD,atrial fibrillation,retention gastric tube,and acid suppressor;GCS score decreased;white blood cell count,neutrophil count,NLR increased significantly;hospital days and hospital mortality rate were extended,SAP consonant rate was also significantly increased(P<0.05).The binary classification logistic showed that NLR was an independent factor affected by the severity of the primary factor(OR=1.256,95%CI=1.151-1.370).The analysis of Spearman shows that the NLR is positively related with the NIHSS(R=0.480,P0.000).3.Compared with non-SAP group,the patients of SAP group were older;the utilization rate of gastric tube and acid suppressor increased significantly;NIHSS is higher;lower GCS;WBC,neutrophil and NLR increased significantly,lymphocyte decreased,hospital days and mortality rate is higher(P<0.05).And the binary classification logistics analysis showed that NLR is an independent factor of SAP(OR=1.200,95%CI=1.104-1.304),ROC curve shows that the NLR ratio has predictive value for SAP(AUC=0.798,95%CI=0.748-0.848).When the NLR truncated value is 5.659,the sensitivity and specificity of SAP in stroke patients is predicted to be 87.3%and 82.3%.Conclusions:1.The NLR was positively correlated with the severity of stroke,and the more severe the stroke severity is,the higher the NLR is.2.NLR has early predictive value for concurrent stroke-associated pneumonia in patients with acute stroke.