Admitting neutrophil/lymphocyte ratio and severity of first-ever acute ischemic stroke among indigenous West Africans

We hypothesized that the neutrophil-lymphocyte ratio (NLR) alone, compared with a combination of the NLR and National Institutes of Health Stroke Scale score (NIHSS) [(NLR + NIHSS)], may help identify persons with severe stroke in a low-resource setting, with few personnel trained to assess the NIHSS score.

We studied 212 participants which included 106 patients with clinico-radiologic diagnosis of AIS and 106 comparative group. At inception, patients with clinico-laboratory features of sepsis, or infection were excluded. Stroke severity was assessed using the Stroke Levity Scale (SLS) and NIHSS scores while NLR was obtained at admission. Factors [beta coefficient (95 % CI)] associated with stroke severity (SLS ≤ 5) were reported using a multi-variable linear regression. A Receiver Operating Characteristics (ROC) curve was used to test the discriminatory ability of the NLR compared with the NLR + NIHSS score in identifying patients with severe stroke (using the SLS score).

Median (IQR) NLR was 2.87 (3.0) among cases and 0.98(0.6) for controls, (p < 0.001). The median (IQR) SLS score of stroke participants was [8.0 (6.0)]. Independent predictors of severe ischemic stroke were baseline NLR [-0.53 (-0.79, -0.26)], admitting GCS [0.31 (0.09, 0.53)], and infarct volume [-0.07 (-0.10, -0.03)]. The NLR alone had an AUC (95 % CI) of 0.82 (0.72-0.92) compared to the NLR + NIHSS score with 0.85 (0.76-0.94).

High admitting NLR is independently associated with severe AIS. In a low-resource setting, with few personnel trained to assess the NIHSS score, the NLR alone may help identify patients with severe AIS.