High Neutrophil-to-Lymphocyte Ratio Predicts One-Year Risk of Pneumonia Post-Stroke Discharge

Clinical Research in Stroke

Sung K.-L.a· Kuo M.-J.a· Hsieh C.-Y.b,c· Sung S.-F.d,e

Author affiliations

aSchool of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
bDepartment of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
cSchool of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
dDivision of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
eDepartment of Beauty and Health Care, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan

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Article / Publication Details

First-Page Preview

Abstract of Clinical Research in Stroke

Received: October 23, 2022
Accepted: January 28, 2023
Published online: March 23, 2023

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Introduction: The neutrophil-to-lymphocyte ratio (NLR) may predict stroke-associated pneumonia, which is generally defined as pneumonia occurring in the first week after stroke. However, little is known whether the initial NLR is associated with pneumonia risk during the long-term follow-up in stroke survivors. We aimed to determine the relationship between admission NLR and the risk of post-stroke pneumonia within 1 year after discharge from acute stroke care. Methods: Hospital databases were searched to identify adult patients hospitalized for acute stroke. Admission NLR was extracted using differential leukocyte counts. The outcome of interest was hospitalized pneumonia occurring within 1 year after discharge from hospitalization for stroke. Multivariable Cox proportional-hazards models were used to determine the independent effects of the NLR on the risk of pneumonia. Results: In this study, 5,741 patients with acute stroke (mean age, 68 years; men, 62.1%) were analyzed. The median NLR was 2.72 (interquartile range, 1.78–4.49). Of the patients, 342 (6.0%) developed pneumonia within 1 year after discharge. In the multivariable models, the NLR was a significant predictor of pneumonia after discharge whether it was analyzed as a continuous or dichotomized variable. The corresponding adjusted hazard ratios were 1.037 (95% confidence interval [CI], 1.013–1.061) and 1.361 (95% CI, 1.087–1.704), respectively. Conclusion: The NLR could predict the risk of post-stroke pneumonia up to 1 year after discharge from acute stroke care. It may help identify high-risk stroke survivors, for whom appropriate interventions can be targeted.

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References Elkind MSV, Boehme AK, Smith CJ, Meisel A, Buckwalter MS. Infection as a stroke risk factor and determinant of outcome after stroke. Stroke. 2020;51(10):3156–68. Westendorp WF, Nederkoorn PJ, Vermeij J-D, Dijkgraaf MG, van de Beek D. Post-stroke infection: a systematic review and meta-analysis. BMC Neurol. 2011;11:110. Bjerkreim AT, Thomassen L, Brøgger J, Waje-Andreassen U, Næss H. Causes and predictors for hospital readmission after ischemic stroke. J Stroke Cerebrovasc Dis. 2015 Sep;24(9):2095–101. Badugu P, Fatima S, Kolikonda M, Karki B, Tella MA, Salunkhe V. Clinical outcomes for patients with community-acquired pneumonia are worse in those with a history of stroke. Univ Louisville J Respir Infect. 2022;6(1). Kishore AK, Vail A, Bray BD, Chamorro A, Napoli MD, Kalra L, et al. Clinical risk scores for predicting stroke-associated pneumonia: a systematic review. Eur Stroke J. 2016;1(2):76–84. Hotter B, Hoffmann S, Ulm L, Meisel C, Bustamante A, Montaner J, et al. External validation of five scores to predict stroke-associated pneumonia and the role of selected blood biomarkers. Stroke. 2021;52(1):325–30. Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474–88. Nam K-W, Kim TJ, Lee JS, Kwon H-M, Lee Y-S, Ko S-B, et al. High neutrophil-to-lymphocyte ratio predicts stroke-associated pneumonia. Stroke. 2018;49(8):1886–92. Cheng W, Chen L, Yu H, Lu D, Yu R, Chen J. Value of combining of the NLR and the fibrinogen level for predicting stroke-associated pneumonia. Neuropsychiatr Dis Treat. 2021;17:1697–705. de Jonge JC, van de Beek D, Lyden P, Brady MC, Bath PM, van der Worp HB. Temporal profile of pneumonia after stroke. Stroke. 2022;53(1):53–60. Zhang J, Ren Q, Song Y, He M, Zeng Y, Liu Z, et al. Prognostic role of neutrophil–lymphocyte ratio in patients with acute ischemic stroke. Medicine. 2017;96(45):e8624. Zhang L, Nie Y, Guo M, Wang L, Shi Y, Jiang X, et al. Neutrophil to lymphocyte ratio as a predictor of long-term outcome in peritoneal dialysis patients: a 5-year cohort study. Blood Purif. 2021;50(6):772–8. Song M, Graubard BI, Rabkin CS, Engels EA. Neutrophil-to-lymphocyte ratio and mortality in the United States general population. Sci Rep. 2021;11(1):464. Drahos J, Vanwormer JJ, Greenlee RT, Landgren O, Koshiol J. Accuracy of ICD-9-CM codes in identifying infections of pneumonia and herpes simplex virus in administrative data. Ann Epidemiol. 2013;23(5):291–3. Skull SA, Andrews RM, Byrnes GB, Campbell DA, Nolan TM, Brown GV, et al. ICD-10 codes are a valid tool for identification of pneumonia in hospitalized patients aged > or = 65 years. Epidemiol Infect. 2008;136(2):232–40. Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013;68(11):1057–65. Wu T, Zhang H, Tian X, Cao Y, Wei D, Wu X. Neutrophil-to-Lymphocyte ratio better than high-sensitivity C-reactive protein in predicting stroke-associated pneumonia in afebrile patients. Neuropsychiatr Dis Treat. 2021;17:3589–95. Wang Q, Liu Y, Han L, He F, Cai N, Zhang Q, et al. Risk factors for acute stroke-associated pneumonia and prediction of neutrophil-to-lymphocyte ratios. Am J Emerg Med. 2021;41:55–9. Dirnagl U, Klehmet J, Braun JS, Harms H, Meisel C, Ziemssen T, et al. Stroke-induced immunodepression: experimental evidence and clinical relevance. Stroke. 2007;38(2 Suppl):770–3. Poznyak A, Grechko AV, Poggio P, Myasoedova VA, Alfieri V, Orekhov AN. The diabetes mellitus–atherosclerosis connection: the role of lipid and glucose metabolism and chronic inflammation. Int J Mol Sci. 2020;21(5):1835. Raggi P, Genest J, Giles JT, Rayner KJ, Dwivedi G, Beanlands RS, et al. Role of inflammation in the pathogenesis of atherosclerosis and therapeutic interventions. Atherosclerosis. 2018;276:98–108. Su Z, Ni P, Zhou C, Wang J. Myeloid-derived suppressor cells in cancers and inflammatory diseases: angel or demon? Scand J Immunol. 2016;84(5):255–61. Kim S, Eliot M, Koestler DC, Wu W-C, Kelsey KT. Association of neutrophil-to-lymphocyte ratio with mortality and cardiovascular disease in the jackson heart study and modification by the duffy antigen variant. Jama Cardiol. 2018;3(6):455–62. Ying Y, Yu F, Luo Y, Feng X, Liao D, Wei M, et al. Neutrophil-to-Lymphocyte ratio as a predictive biomarker for stroke severity and short-term prognosis in acute ischemic stroke with intracranial atherosclerotic stenosis. Front Neurol. 2021;12:705949. Grossmann I, Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, et al. Stroke and pneumonia: mechanisms, risk factors, management, and prevention. Cureus. 2021;13(11):e19912. Woo D, Broderick JP, Kothari RU, Lu M, Brott T, Lyden PD, et al. Does the national Institutes of health stroke Scale favor left hemisphere strokes? NINDS t-PA stroke study group. Stroke. 1999 Nov;30(11):2355–9. Hug A, Dalpke A, Wieczorek N, Giese T, Lorenz A, Auffarth G, et al. Infarct volume is a major determiner of post-stroke immune cell function and susceptibility to infection. Stroke. 2009;40(10):3226–32. Harms H, Reimnitz P, Bohner G, Werich T, Klingebiel R, Meisel C, et al. Influence of stroke localization on autonomic activation, immunodepression, and post-stroke infection. Cerebrovasc Dis. 2011;32(6):552–60. Urra X, Laredo C, Zhao Y, Amaro S, Rudilosso S, Renú A, et al. Neuroanatomical correlates of stroke-associated infection and stroke-induced immunodepression. Brain Behav Immun. 2017;60:142–50. Article / Publication Details

First-Page Preview

Abstract of Clinical Research in Stroke

Received: October 23, 2022
Accepted: January 28, 2023
Published online: March 23, 2023

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

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