scholarly journals High Neutrophil–Lymphocyte Ratio Predicts Post-stroke Cognitive Impairment in Acute Ischemic Stroke Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Minwoo Lee ◽  
Jae-Sung Lim ◽  
Chul-Ho Kim ◽  
Sang-Hwa Lee ◽  
Yerim Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Systemic Inflammation ◽  
Cognitive Outcomes ◽  
Stroke Patients ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Post Stroke ◽  
Increased Risk ◽  
The Impact

Background and Aims: Systemic inflammation is associated with an increased risk of cognitive impairment and dementia, but the associations between them in stroke patients are less clear. We examined the impact of systemic inflammation represented as the neutrophil-lymphocyte ratio (NLR) on the development of post-stroke cognitive impairment (PSCI) and domain-specific cognitive outcomes 3-month after ischemic stroke.Methods: Using prospective stroke registry data, we consecutively enrolled 345 participants with ischemic stroke whose cognitive functions were evaluated 3-month after stroke. Their cognition was assessed with the Korean version of the Vascular Cognitive Impairment Harmonization Standards and the Korean-Mini Mental Status Examination. PSCI was defined as a z-score of < -2 standard deviations for age, sex, and education adjusted means in at least one cognitive domain. The participants were categorized into five groups according to the quintiles of NLR (lowest NLR, Q1). The cross-sectional association between NLR and PSCI was assessed using multiple logistic regression, adjusting for age, sex, education, vascular risk factors, and stroke type.Results: A total of 345 patients were enrolled. The mean age was 63.0 years and the median NIHSS score and NLR were 2 [1–4] and 2.26 [1.65–2.91], respectively. PSCI was identified in 71 (20.6%) patients. NLR was a significant predictor for PSCI both as a continuous variable (adjusted OR, 1.14; 95% CI, 1.00–1.31) and as a categorical variable (Q5, adjusted OR, 3.26; 95% CI, 1.17–9.08). Patients in the Q5 group (NLR ≥ 3.80) showed significantly worse performance in global cognition and in visuospatial and memory domains.Conclusions: NLR in the acute stage of ischemic stroke was independently associated with PSCI at 3 months after stroke, and high NLR was specifically associated with cognitive dysfunction in the memory and visuospatial domains. Thus, systemic inflammation may be a modifiable risk factor that may influence cognitive outcomes after stroke.

Abstract TMP80: Relationship Between Neutrophil/Lymphocyte Ratio and Post-stroke Depression

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ann N Lucke-Wold ◽  
Michael D Regier ◽  
Ashley Petrone ◽  
Connie Tennant ◽  
Taura Barr
Keyword(s):  
Ischemic Stroke ◽  
Hospital Admission ◽  
Wilcoxon Test ◽  
P Value ◽  
Depression Symptoms ◽  
Stroke Patients ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Post Stroke ◽  
Post Stroke Depression

Background: Depression is a leading cause of disability post-stroke. Nearly a third of stroke victims suffer from depression after event occurrence. Post-stroke depression hinders physical rehabilitation, decreases quality of life, and has a negative effect on long-term survivability. Inflammatory processes post-ischemic stroke are likely associated with the development of depression. The neutrophil-lymphocyte ratio (NLR) is a routinely available marker of systemic inflammation and could serve as a prognostic tool at hospital admission for post-stroke depression. The goal of this project was to determine the relationship between admission NLR and depression 30 and 90 days post-stroke. Methods: 58 ischemic stroke patients were recruited from a regional primary stroke center and followed up to 90 days post stroke. NLR levels were drawn at Emergency Department admission and at 24 hours. The Quick Inventory for Depression Symptomology (QIDS) was used to measure depression symptoms at 24 hours, 30 days and 90 days post stroke. We scaled continuous variables by their standard deviation and used the Box-Cox or exponential transformation if the skew was greater than 0.5. An age-adjusted Pearson's correlation was utilized to assess bivariate relationships. Other methods used include Mann-Whitney-Wilcoxon test and Fisher's Exact test when appropriate to compare ischemic and non-stroke patients. Results: Adjustments for age were included due to weak to strong correlations with various measures of NLR and QIDS. There is a statistically significant correlation between the baseline NLR and baseline QIDS (correlation = -0.54, p-value=0.013) and QIDS at 30 days (correlation=-0.67, p-value=0.028). NLR at 24 hours has a statistically moderate correlation with QID at 30 days (correlation=0.39, p-value=0.055) and QIDS at 90 days (correlation=0.36, p-value=0.134). Conclusions: This preliminary study suggests that NLR at hospital admission could serve as a prognostic marker of post stroke depression at thirty days. Utilization of this marker in clinical practice for stroke care could identify high risk patients and result in earlier treatment of depression. Validation studies and preventative strategies will need to be explored in future studies.

scholarly journals Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study

2020 ◽  
Vol 77 (3) ◽  
pp. 1157-1167
Author(s):  
Zhirong Yang ◽  
Duncan Edwards ◽  
Stephen Burgess ◽  
Carol Brayne ◽  
Jonathan Mant
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Practice Research Datalink ◽  
Atherosclerotic Cardiovascular Disease ◽  
Stroke Patients ◽  
Post Stroke ◽  
Increased Risk ◽  
The Impact

Background: Prior atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD) and peripheral artery disease (PAD), are common among patients with stroke, a known risk factor for dementia. However, whether these conditions further increase the risk of post-stroke dementia remains uncertain. Objective: To examine whether prior ASCVD is associated with increased risk of dementia among stroke patients. Methods: A retrospective cohort study was conducted using the Clinical Practice Research Datalink with linkage to hospital data. Patients with first-ever stroke between 2006 and 2017 were followed up to 10 years. We used multi-variable Cox regression models to examine the associations of prior ASCVD with dementia and the impact of prior ASCVD onset and duration. Results: Among 63,959 patients, 7,265 cases (11.4%) developed post-stroke dementia during a median of 3.6-year follow-up. The hazard ratio (HR) of dementia adjusted for demographics and lifestyle was 1.18 (95% CI: 1.12–1.25) for ASCVD, 1.16 (1.10–1.23) for CHD, and 1.25 (1.13–1.37) for PAD. The HRs additionally adjusted for multimorbidity and medications were 1.07 (1.00–1.13), 1.04 (0.98–1.11), and 1.11 (1.00–1.22), respectively. Based on the fully adjusted estimates, there was no linear relationship between the age of ASCVD onset and post-stroke dementia (all p-trend >0.05). The adjusted risk of dementia was not increased with the duration of pre-stroke ASCVD (all p-trend >0.05). Conclusion: Stroke patients with prior ASCVD are more likely to develop subsequent dementia. After full adjustment for confounding, however, the risk of post-stroke dementia is attenuated, with only a slight increase with prior ASCVD.

Serum Periostin and Cognitive Impairment in Ischemic Stroke Patients: a Prospective Cohort Study

2021 ◽  
Author(s):  
Guangzong Li ◽  
Jie Li ◽  
Chen Zhu ◽  
Jing Ye ◽  
Bin Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Enzyme Linked Immunosorbent Assay ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Increased Risk ◽  
Serum Periostin

Abstract Background. Recent evidence suggest elevated periostin is associated with cardiovascular diseases. The aim of this study was to investigate the relationship between serum periostin and post-stroke cognitive impairment (PSCI) at 3 months. Methods. In this prospective cohort study, we enrolled patients with ischemic stroke and hospitalized within 7 days of symptoms onset from January 2019 to January 2020. Serum periostin levels were measured using enzyme-linked immunosorbent assay after admission. Cognitive function assessment was performed at 3-month follow-up visit using the Montreal Cognitive Assessment (MoCA). We defined the PSCI as total MoCA score < 25. Results. A total of 315 ischemic stroke patients were enrolled for the study. PSCI was observed in 173 patients, which accounted for 54.9% (95% confidence interval [CI] 52.1%–57.7%) of the cohort. Serum periostin levels were higher in patients with PSCI than in those without PSCI (median 19.6 vs 14.8 ng/mL; P = 0.001). In logistic regression analysis, the highest quartile of periostin levels were significantly correlated to PSCI (odds ratio [OR], 9.69; 95% CI, 5.06–25.61; P = 0.001), as compared with the lowest quartile. This association remained significant after adjustment for age, gender, educational years, stroke severity, and vascular risk factors. Subgroup analyses further confirmed these results. Furthermore, restricted cubic spline regression demonstrated a linear association between periostin levels and PSCI (P = 0.001 for linearity).Conclusions. This study found that higher serum periostin levels are associated with an increased risk of PSCI at 3 months after ischemic stroke onset.

scholarly journals Soluble ST2 and risk of cognitive impairment after acute ischemic stroke: a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yinwei Zhu ◽  
Chongquan Fang ◽  
Qi Zhang ◽  
Yaling Lu ◽  
Rui Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Acute Ischemic Stroke ◽  
Sex Education ◽  
Mmse Score ◽  
Cognitive Status ◽  
Stroke Patients ◽  
The Impact ◽  
State Examination ◽  
Conventional Risk Factors

Abstract Background Soluble suppression of tumorigenesis-2 (sST2) was reported to be associated with cognitive performance and risk of incident stroke. However, the impact of sST2 on cognitive function after ischemic stroke is unclear. We aimed to assess the association of sST2 and cognitive impairment at 3 months in acute ischemic stroke patients. Methods Baseline plasma sST2 levels were measured in 619 ischemic stroke patients (mean age: 60.0 ± 10.5 years) from 7 participating hospitals of the China Antihypertensive Trial in Acute Ischemic Stroke. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to assess cognitive status. Cognitive impairment was defined as a MoCA score < 23 or MMSE score < 27. The association between sST2 and cognitive impairment was evaluated by logistic regression analysis. Results 325 (52.5%) or 323 (52.2%) participants developed cognitive impairment according to MoCA or MMSE. After adjustment for age, sex, education, and other covariates, the odds ratio for the highest vs lowest quartile of sST2 was 2.38 (95% CI, 1.42–4.00) and 1.82 (95% CI 1.09–3.03) risk of cognitive impairment defined by MoCA and MMSE score, respectively. Incorporation sST2 into a model containing conventional risk factors significantly improved reclassification. Conclusions Elevated plasma sST2 levels were significantly associated with post-stroke cognitive impairment.

scholarly journals The impact of post-stroke complications on in-hospital mortality depends on stroke severity

2016 ◽  
Vol 2 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Alejandro Bustamante ◽  
Dolors Giralt ◽  
Teresa García-Berrocoso ◽  
Marta Rubiera ◽  
José Álvarez-Sabín ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Random Forest ◽  
Hospital Mortality ◽  
Brain Edema ◽  
Respiratory Infections ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Post Stroke ◽  
The Impact

Introduction Controversies remain on whether post-stroke complications represent an independent predictor of poor outcome or just a reflection of stroke severity. We aimed to identify which post-stroke complications have the highest impact on in-hospital mortality by using machine learning techniques. Secondary aim was identification of patient’s subgroups in which complications have the highest impact. Patients and methods Registro Nacional de Ictus de la Sociedad Española de Neurología is a stroke registry from 42 centers from the Spanish Neurological Society. Data from ischemic stroke patients were used to build a random forest by combining 500 classification and regression trees, to weight up the impact of baseline characteristics and post-stroke complications on in-hospital mortality. With the selected variables, a logistic regression analysis was performed to test for interactions. Results 12,227 ischemic stroke patients were included. In-hospital mortality was 5.9% and median hospital stay was 7(4–10) days. Stroke severity [National Institutes of Health Stroke Scale > 10, OR = 5.54(4.55–6.99)], brain edema [OR = 18.93(14.65–24.46)], respiratory infections [OR = 3.67(3.02–4.45)] and age [OR = 2.50(2.07–3.03) for >77 years] had the highest impact on in-hospital mortality in random forest, being independently associated with in-hospital mortality. Complications have higher odds ratios in patients with baseline National Institutes of Health Stroke Scale <10. Discussion Our study identified brain edema and respiratory infections as independent predictors of in-hospital mortality, rather than just markers of more severe strokes. Moreover, its impact was higher in less severe strokes, despite lower frequency. Conclusion Brain edema and respiratory infections were the complications with a greater impact on in-hospital mortality, with the highest impact in patients with mild strokes. Further efforts on the prediction of these complications could improve stroke outcome.

scholarly journals RISK OF POST STROKE PNEUMONIA DURING HOSPITALIZATION

2021 ◽  
Vol 4 (IAHSC) ◽  
pp. 108-113
Author(s):  
Juliana Gracia G.E.P Massie ◽  
Ratna Sitorus ◽  
I Made Kariasa ◽  
Yunisar Gultom ◽  
Maya Khairani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Discrimination Performance ◽  
Diagnostic Study ◽  
Common Complication ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Post Stroke ◽  
Increased Risk ◽  
Nursing Team

Introduction: Post-stroke pneumonia is the most a common complication during the first few weeks after a stroke. Thus, a score is needed for the early identification of stroke patients with an increased risk of pneumonia to assist the nursing team in preventing the onset of pneumonia in stroke patients during hospitalization. This study aimed to assess the application of the A2DS2 score to predict pneumonia in acute ischemic stroke patients. Method: This is a diagnostic study that used a cross-sectional method conducted among adult acute ischemic stroke patients. Data analysis was performed to assess the calibration and discrimination performance of the A2DS2 score. Results: A total of 16 respondents were followed up. The incidence of post-stroke pneumonia was observed in 6 patients (37.5%). Conclusion: This scoring proved clinically accurate to predict the incidence of pneumonia in acute ischemic stroke patients.

SERUM MALONDIALDEHYDE AS A PREDICTOR OF POST-STROKE COGNITIVE IMPAIRMENT IN ISCHEMIC STROKE PATIENTS.

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Wael Mahmoud ◽  
Elhady Abd-Elgawad ◽  
Dalia Mesallam ◽  
Tamer El-Serafy
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Stroke Patients ◽  
Post Stroke

scholarly journals KORELASI ANTARA RASIO NEUTROFIL LIMFOSIT DENGAN VOLUME INFARK SEREBRI PADA PENDERITA STROKE ISKEMIK AKUT

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Ilsa Hunaifi ◽  
Triana Dyah Cahyawati
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Cross Sectional Design

 CORRELATION BETWEEN NEUTROFIL LIMPHOCYTE RATIO AND CEREBRAL INFARCTION VOLUME IN ACUTE ISCHAEMIC STROKEABSTRACTIntroduction: Inflammation plays a key role in stroke pathophysiology. Neutrophils is one of the earliest leucocyte subtypes to infiltrate the ischemia area of the brain. The neutrophil-lymphocyte ratio (NLR) is independent of the severity of coronary heart disease and as a predictor of poor clinical outcomes in patients with coronary heart disease undergoing angiography. The neutrophil-lymphocyte ratio values may be a prognostic factor in ischemic stroke patients. The neutrophil- lymphocyte ratio values can also be used in predicting infarct size, however limited study has been conducted in this area.Aim: To determine the correlation of NLR with cerebral infarct volume in acute ischemic stroke patients.Method: This was an analytical observational study with cross sectional design. The population for this study were acute ischemic stroke patients at NTB Genereal Hospital. The collected data were analyzed by Spearman correlation test.Results: Approximately 52 participants  were enrolled in this study with mean age was 59.79±8.65 years old. Hypertension was a common modifiable risk factor identified in more than 94.2 % participant. The mean of neutrophil lymphocyte ratio was 3.94±2.96 and mean of infarct volume was 13.96±37.26cm3. There was correlation between RNL and cerebral infract volume (r=+0.351; p=0.023).Discussions: Higher lymphocyte neutrophil ratio in acute ischemic stroke patients would result in an increase of brain infarct volume.Keyword: Infarct volume, ischaemic stroke, neutrophil lymphocyte ratioABSTRAKPendahuluan: Inflamasi memegang peranan penting dalam patofisiologi stroke. Salah satu subtipe dari sel leukosit yang paling awal menginfiltrasi ke area iskemia di otak adalah neutrofil. Rasio neutrofil limfosit (RNL) merupakan faktor independen terhadap beratnya penyakit jantung koroner dan sebagai prediktor luaran klinis yang buruk pada penderita penyakit jantung koroner yang menjalani angiografi. Nilai RNL dapat menjadi faktor prognostik pada penderita stroke iskemik. Nilai RNL juga bisa digunakan dalam memprediksi ukuran infark namun belum dilakukan penelitian hingga saat ini.Tujuan: Mengetahui korelasi RNL dengan volume infark serebri pada penderita stroke iskemik akut.Metode: Penelitian analitik observasional dengan desain potong lintang terhadap pasien stroke iskemik akut di RSUP NTB. Data yang terkumpul dianalisis dengan uji korelasi Spearman.Hasil: Didapatkan 52 subjek dengan rerata umur 59,79±8,65 tahun dan faktor risiko utama hipertensi (94,2%). Didapatkan rerata rasio neutrofil limfosit 3,94±2,96 dan rerata volume infark 13,96±37,26cm3. Terdapat korelasi antara RNL dengan volume infark serebri (r=+0,351; p=0,023).Diskusi: Semakin tinggi nilai rasio neutrofil limfosit mengakibatkan semakin luasnya volume infark serebri pada penderita stroke iskemik akut.Kata kunci: Rasio neutrofil limfosit, stroke iskemik, volume infark  

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