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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01032

Clinical significance of baseline neutrophil to lymphocyte ratio in patients with ischemic stroke or hemorrhagic stroke:An updated meta-analysis

 Siying Song1, 2, 3,  Ran Meng1, 2, 3*, Xiaoxi Zhao1, Chang Hua4, Ruijun Kang5, Yipeng Han6 and Xin Ma1*
  • 1Xuanwu Hospital, Capital Medical University, China
  • 2Center of Stroke, Beijing Institute for Brain Disorders, China
  • 3Institute of Cerebrovascular Disease Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, China
  • 4Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China
  • 5Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, China
  • 6Capital Medical University, China

Background and purpose: Study on the relationship between baseline neutrophil to lymphocyte ratio (NLR) and stroke, and analyze the prognostic value of NLR in subtypes of stroke.
Methods: This meta-analysis was registered in PROSPERO with the number CRD42018105305. We went through relevant articles from PubMed Central (PMC) and EMBASE, included either prospective or retrospective studies about baseline NLR level before any treatment in patients with ischemic or hemorrhagic stroke, to identify studies up to April 2019. The cut-off value for NLR and the sources of ORs/RRs were measured. Modified Rankin Scale (mRS) was used to investigate the outcomes during clinical follow-up. Predefined criteria were used to evaluate the risk of bias in eligible studies. P-values < 0.05 were considered statistically significant. STATA version 14.0 (STATA, College Station, TX) was used in all analyses.
Results: 37 studies with 43,979 individuals were included in the final analysis. Higher NLR level was corelated with increased risk of ischemic stroke (ORs/RRs = 1.609; 95% CI = 1.283 - 2.019), unfavorable functional outcome at 3 months (ORs/RRs = 1.851; 95% CI = 1.325 - 2.584) and increased mortality in patients with ischemic stroke (ORs/RRs = 1.068; 95% CI = 1.027 - 1.111). While in terms of hemorrhagic stroke (including SAH and ICH), elevated NLR level only had deleterious effect on mortality (ORs/RRs = 1.080; 95% CI = 1.018 - 1.146).
Conclusions: Baseline NLR level is a promising predictor of the clinical outcomes in both ischemic and hemorrhagic stroke. In addition, elevated NLR is also associated with a high risk of ischemic stroke occurrence. However, future studies are needed to demonstrate the underlying mechanisms.

Keywords: Neutrophil to lymphocyte ratio, Stroke, Mortality, functional outcome after acute stroke, Meta-analysis

Received: 23 Jun 2019; Accepted: 11 Sep 2019.

Copyright: © 2019 Song, Meng, Zhao, Hua, Kang, Han and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Dr. Ran Meng, Xuanwu Hospital, Capital Medical University, Beijing, 100053, Beijing Municipality, China, victor65@126.com
Dr. Xin Ma, Xuanwu Hospital, Capital Medical University, Beijing, 100053, Beijing Municipality, China, maxin118@hotmail.com