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Lymphocyte-to-Monocyte Ratio Is Independently Associated with Progressive Infarction in Patients with Acute Ischemic
Xiaocheng Mao1, Qiulong Yu1, Yunfang Liao2
1Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000 Jiangxi, China.
Methods:
From April 2017 to December 2020, we retrospectively recruited 477 patients with acute ischemic stroke (within 48 hours after onset). Progressive infarction was defined as an increase of ≥1 point in motor power or ≥2 points on the total National Institutes of Health Stroke Scale (NIHSS) within 7 days after admission and extension of the original infarction were further confirmed by diffusion-weighted imaging. Demographic characteristics, clinical information, and neuroimaging characteristics were evaluated after admission. All blood draws and initial imaging were completed within 24 hours of admission.
Results:
PI occurred in 147 (30.8%) patients. Univariate analysis comparing the two groups revealed that hypertension, initial NIHSS score, discharge NIHSS score, modified Rankin scale score at 90 days, monocyte level, creatinine level, fasting glucose level, LMR, monocyte-to-high-density lipoprotein ratio (MHR), and lesion location were significantly different (P < 0.05). Multivariate logistic regression analysis showed that the odds ratio of PI increased as the quartile of LMR increased, with the lowest quartile as the reference value. Subgroup analyses showed that a high LMR was an independent predictor of PI only in large artery atherosclerosis (LAA) patients. The receiver operating characteristic (ROC) curve was drawn to estimate the predictive value of LMR for PI. For all cases, the area under the curve was 0.583 (95% CI 0.526-0.641), and the best predictive cutoff value was 3.506, with a sensitivity of 53.1% and a specificity of 63.9%. In patients with LAA, the area under the curve was 0.585 (95% CI 0.505-0.665), and the best predictive cutoff value was 3.944, with a sensitivity of 48.7% and a specificity of 72.8%.
Conclusions:
LMR was an independent predictor for progressive infarction in patients with acute ischemic stroke, especially in LAA cerebral infarction patients.
Insights
The monocyte-to-lymphocyte ratio (LMR) predicts progressive infarction in acute ischemic stroke patients. This ratio is particularly useful for identifying risk in those with large artery atherosclerosis (LAA) stroke.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Biochemistry
Background:
- Progressive infarction (PI) is a significant complication in acute ischemic stroke (AIS).
- Identifying predictors of PI is crucial for timely intervention and improved patient outcomes.
- The monocyte-to-lymphocyte ratio (LMR) has emerged as a potential biomarker in various inflammatory conditions.
Purpose of the Study:
- To investigate the association between LMR and the occurrence of PI in AIS patients.
- To determine if LMR can serve as an independent predictor for PI.
- To explore the predictive value of LMR in specific stroke etiologies, particularly large artery atherosclerosis (LAA).
Main Methods:
- Retrospective analysis of 477 AIS patients admitted within 48 hours of symptom onset.
- Definition of PI based on neurological improvement and diffusion-weighted imaging confirmation.
- Evaluation of demographic, clinical, and neuroimaging data, including LMR, monocytes, and creatinine levels.
Main Results:
- Progressive infarction (PI) occurred in 30.8% of patients.
- Univariate analysis identified significant differences in LMR, NIHSS scores, and other clinical factors between patients with and without PI.
- Multivariate analysis revealed LMR as an independent predictor of PI, with increased risk observed at higher LMR quartiles. Subgroup analysis highlighted LMR's predictive value specifically in LAA patients.
Conclusions:
- The monocyte-to-lymphocyte ratio (LMR) is an independent predictor of progressive infarction in acute ischemic stroke.
- LMR demonstrates particular utility in predicting PI in patients with large artery atherosclerosis (LAA) cerebral infarction.
- The study suggests LMR can aid in risk stratification for progressive infarction in AIS.
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