Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis
Background and purpose: Stroke is a leading cause of death and acquired disability in adults today. Inflammation plays an important role in the pathophysiology of stroke. The peripheral neutrophil-to-lymphocyte ratio (NLR) is an important global inflammatory indicator becoming more mainstream in str...
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doaj-340a44f0ff6647c6abb1e0a277c10af22020-11-25T01:58:21ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-10-011010.3389/fneur.2019.01032480285Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-AnalysisSi-Ying Song0Si-Ying Song1Si-Ying Song2Xiao-Xi Zhao3Gary Rajah4Gary Rajah5Gary Rajah6Chang Hua7Rui-jun Kang8Yi-peng Han9Yu-chuan Ding10Ran Meng11Ran Meng12Ran Meng13Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, ChinaAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, ChinaDepartment of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United StatesDepartment of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United StatesDepartment of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, United StatesDepartment of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, ChinaDepartment of Ultrasonography, Tiantan Hospital, Capital Medical University, Beijing, ChinaSchool of Basic Medical Sciences, Capital Medical University, Beijing, ChinaDepartment of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United StatesDepartment of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, ChinaAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, ChinaDepartment of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, ChinaBackground and purpose: Stroke is a leading cause of death and acquired disability in adults today. Inflammation plays an important role in the pathophysiology of stroke. The peripheral neutrophil-to-lymphocyte ratio (NLR) is an important global inflammatory indicator becoming more mainstream in stroke care. This meta-analysis aims to evaluate the relationship between the baseline NLR and acute ischemic and hemorrhagic stroke, as well as define the clinical significance of NLR in subtypes of ischemic stroke.Methods: This meta-analysis was registered in PROSPERO with the number CRD42018105305. We went through relevant articles from PubMed Central (PMC) and EMBASE. Prospective and retrospective studies were included if related to baseline NLR levels prior to treatment in patients with ischemic or hemorrhagic stroke. Studies were identified up until April 2019. The cutoff value for NLR and the sources of odds ratios (ORs)/risk ratios (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 statistical analyses.Results: Thirty-seven studies with 43,979 individuals were included in the final analysis. Higher NLR levels were correlated 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 levels only had deleterious effects 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 and further explain this association.https://www.frontiersin.org/article/10.3389/fneur.2019.01032/fullneutrophil-to-lymphocyte ratiostrokemortalityfunctional outcomemeta-analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Si-Ying Song Si-Ying Song Si-Ying Song Xiao-Xi Zhao Gary Rajah Gary Rajah Gary Rajah Chang Hua Rui-jun Kang Yi-peng Han Yu-chuan Ding Ran Meng Ran Meng Ran Meng |
spellingShingle |
Si-Ying Song Si-Ying Song Si-Ying Song Xiao-Xi Zhao Gary Rajah Gary Rajah Gary Rajah Chang Hua Rui-jun Kang Yi-peng Han Yu-chuan Ding Ran Meng Ran Meng Ran Meng Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis Frontiers in Neurology neutrophil-to-lymphocyte ratio stroke mortality functional outcome meta-analysis |
author_facet |
Si-Ying Song Si-Ying Song Si-Ying Song Xiao-Xi Zhao Gary Rajah Gary Rajah Gary Rajah Chang Hua Rui-jun Kang Yi-peng Han Yu-chuan Ding Ran Meng Ran Meng Ran Meng |
author_sort |
Si-Ying Song |
title |
Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis |
title_short |
Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis |
title_full |
Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis |
title_fullStr |
Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis |
title_full_unstemmed |
Clinical Significance of Baseline Neutrophil-to-Lymphocyte Ratio in Patients With Ischemic Stroke or Hemorrhagic Stroke: An Updated Meta-Analysis |
title_sort |
clinical significance of baseline neutrophil-to-lymphocyte ratio in patients with ischemic stroke or hemorrhagic stroke: an updated meta-analysis |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2019-10-01 |
description |
Background and purpose: Stroke is a leading cause of death and acquired disability in adults today. Inflammation plays an important role in the pathophysiology of stroke. The peripheral neutrophil-to-lymphocyte ratio (NLR) is an important global inflammatory indicator becoming more mainstream in stroke care. This meta-analysis aims to evaluate the relationship between the baseline NLR and acute ischemic and hemorrhagic stroke, as well as define the clinical significance of NLR in subtypes of ischemic stroke.Methods: This meta-analysis was registered in PROSPERO with the number CRD42018105305. We went through relevant articles from PubMed Central (PMC) and EMBASE. Prospective and retrospective studies were included if related to baseline NLR levels prior to treatment in patients with ischemic or hemorrhagic stroke. Studies were identified up until April 2019. The cutoff value for NLR and the sources of odds ratios (ORs)/risk ratios (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 statistical analyses.Results: Thirty-seven studies with 43,979 individuals were included in the final analysis. Higher NLR levels were correlated 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 levels only had deleterious effects 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 and further explain this association. |
topic |
neutrophil-to-lymphocyte ratio stroke mortality functional outcome meta-analysis |
url |
https://www.frontiersin.org/article/10.3389/fneur.2019.01032/full |
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