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Inflammatory markers as independent predictors for stroke outcomes
Xiao-Guang Zhang1, Jie Xue1, Wen-Hao Yang1
1Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China.
Insights
Inflammatory markers like neutrophil, lymphocyte, and C-reactive protein (CRP) levels predict ischemic stroke outcomes. The neutrophil-lymphocyte ratio and CRP were the strongest independent predictors for mortality and functional status.
Area of Science:
- Neurology
- Immunology
- Biostatistics
Background:
- Inflammation is a key factor in stroke pathophysiology.
- Understanding inflammatory markers' role in stroke is crucial for predicting outcomes.
Purpose of the Study:
- To investigate the association between inflammatory risk markers and ischemic stroke outcome.
- To determine the predictive value of inflammatory markers for stroke subtypes and mortality.
Main Methods:
- Retrospective study of 3,013 ischemic stroke patients.
- Analysis of inflammatory markers: white blood cell (WBC) count, neutrophil, lymphocyte, C-reactive protein (CRP), and interleukin-6 (IL-6).
- Multivariate logistic regression and Naive Bayes model used to identify independent predictors of outcome.
Main Results:
- Neutrophil and WBC counts were higher in large-artery atherosclerosis (LAA) and cardioembolism (CE) subtypes.
- Lymphocyte levels were higher in small-artery occlusion (SAO).
- Neutrophil-lymphocyte ratio and CRP levels demonstrated the strongest independent predictive value for all outcomes.
Conclusions:
- Inflammatory markers, including neutrophil, lymphocyte, and CRP, possess significant independent predictive value for stroke outcomes.
- These markers can aid in assessing prognosis and guiding treatment strategies for ischemic stroke patients.
Background:
Inflammation plays an important role in the pathophysiology of stroke. The aim of the present study was to investigate the association between various inflammatory risk markers and ischemic stroke outcome and subtype.
Methods:
A total of 3,013 ischemic stroke patients who were admitted to our hospital from 01/01/2016 to 12/30/2018 were retrospectively studied. Stroke subtypes were defined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Levels of five common inflammatory markers including white blood cell (WBC) count, neutrophil, lymphocyte, serum C-reactive protein (CRP), and interleukin-6 (IL-6) were measured, and eleven conventional risk factors were further evaluated in the prediction of overall mortality as well as three functional outcomes defined by the National Institute of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel Index (BI). Independent predictors of outcome were identified by multivariate logistic regression, and an importance score measured by the area under the receiver operating characteristics curve for each predictor using a Naive Bayes model was reported.
Results:
Neutrophil and WBC were significantly higher in large-artery atherosclerosis (LAA) and cardioembolism (CE) subtype. In contrast, lymphocyte was significantly higher in small-artery occlusion (SAO). Neutrophil-lymphocyte ratio and CRP level were the best independent predictors, after adjustment for traditional risk factors and TOAST subtype for all four types of outcomes.
Conclusion:
Inflammatory risk markers including neutrophil, lymphocyte, and CRP may have strong independent prediction values for stroke outcome.
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