The Ratio Paradox in Stroke Prognosis: Abundant Evidence, Absent Utility

Laboratory ratios such as the neutrophil-to-lymphocyte, platelet-to-lymphocyte, and stress hyperglycemia ratios have been widely studied as prognostic markers in stroke. Despite hundreds of reports and multiple meta-analyses, these indices have shown modest effect sizes and have not influenced clinical guidelines or trial design. This commentary argues that such ratios serve as surrogates of systemic physiology rather than actionable prognostic tools, highlighting the gap between statistical association and clinical translation.