ORIGINAL RESEARCH article
Front. Med.
Sec. Translational Medicine
Diagnostic Prediction Model for Acute Ischemic Stroke Using Stress Hyperglycemia and Neutrophil-to-Lymphocyte Ratios
Provisionally accepted
- Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Objectives: To develop a diagnostic prediction model for acute ischemic stroke (AIS) integrating the stress hyperglycemia ratio (SHR) and neutrophil-to-lymphocyte ratio (NLR), and to evaluate their relevance to neurological severity and stroke etiology. Methods: We retrospectively analyzed consecutive adults hospitalized with AIS from August 2023 to January 2024, compared with a control group undergoing routine health examinations during the same period. Comprehensive clinical, laboratory, and imaging data were collected. Multivariable logistic regression was employed to develop diagnostic models, with performance evaluated using receiver operating characteristic (ROC) curve analysis. Model interpretability was evaluated using Shapley Additive Explanations (SHAP), and nonlinear associations with National Institutes of Health Stroke Scale (NIHSS) scores were investigated using restricted cubic splines. Bayesian discriminant analysis and ROC curves examined biomarker differences across TOAST subtypes. Results: Among 666 patients with AIS and 558 controls, elevated NLR and higher SHR were independently associated with AIS risk (both p ≤ 0.001) and greater neurological impairment. The optimal model, incorporating SHR, NLR, age, sex, HCy, HDL-C, and triglycerides, demonstrated high discrimination (AUC=0.891, 95% CI 0.872–0.908; sensitivity 83.3%; specificity 78.5%). SHAP analysis ranked NLR as the strongest contributor. Nonlinear, U-or J-shaped relationships with NIHSS severity were identified, with risk increasing above SHR=0.75 and NLR=2.86. Combined SHR+NLR showed the greatest utility for identifying cardioembolic stroke (AUC=0.732). Conclusion: This preliminary study demonstrates that SHR and NLR, as readily available biomarkers, independently predict AIS severity and facilitate subtype differentiation. Their combined assessment enhances early diagnostic performance. However, validation studies are required to confirm their clinical utility and inform biomarker-based management strategies.
Keywords: Stress-Hyperglycemia Ratio, Neutrophil-to-lymphocyte ratio, Acute ischemic stroke, predictive model, National Institutes of Health Stroke Scale, TOAST
Received: 02 Oct 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Jiang, Zhang and Wang. 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) or licensor 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: Yi Jiang, jiangyi@njmu.edu.cn
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