title: Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease.
abstract: BACKGROUND
  Inflammation plays a role in the pathogenesis of carotid atherosclerosis. Although previous data demonstrated an association between inflammatory biomarkers and stroke, there is no publication reporting the relation of neutrophil to lymphocyte (N/L) ratio with ischemic stroke. We aimed to analyze the predictive ability of N/L ratio in acute ischemic cerebrovascular disease.
  
  
  METHODS
  A total of 190 patients including 70 patients with first-ever atherothrombotic acute ischemic stroke (AAIS), 50 patients with transient ischemic attack, and 70 healthy subjects were enrolled in this study. We analyzed the values of white blood cell (WBC), N/L ratio, C-reactive protein (CRP), gamma-glutamyltransferase (GGT), homocysteine (HCY), mean platelet volume (MPV) in patients with ischemic group and compared those with control individuals.
  
  
  RESULTS
  WBC, CRP, HCY, N/L ratio were found to increase significantly in AAIS patients than the controls (P < 0.001). With respect to mortality, there were no significant differences between the values of CRP, GGT, HCY, and MPV in patients with AAIS. However, WBC and N/L ratio values were found to increase significantly in dead patients (P = 0.024 and P = 0.029, respectively). A comparison of receiver operating characteristic curves among WBC, CRP, GGT, HCY, MPV, and N/L ratio variables was made. No significant differences were obtained between area under curve values (P > 0.05). A cut-off value of 4.1 for N/L ratio was detected in predicting mortality with a sensitivity of 66.7% and a specificity of 74.1% (κ = 0.299, P = 0.006).
  
  
  CONCLUSIONS
  These findings support the role of N/L ratio as a simple inexpensive and readily available marker of prognosis in acute ischemic stroke.
authors.affiliation: Department of Neurology, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Asuman
authors.initials: A
authors.lastname: Celikbilek
authors.forename: Sevda
authors.initials: S
authors.lastname: Ismailogullari
authors.forename: Gokmen
authors.initials: G
authors.lastname: Zararsiz
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000401:mortality; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D063847:Mean Platelet Volume; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D011379:Prognosis; D012372:ROC Curve; D013927:Thrombosis / Q000097:blood / Q000150:complications; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D006710:Homocysteine; D002097:C-Reactive Protein; D005723:gamma-Glutamyltransferase
keywords: ischemic stroke; neutrophil to lymphocyte ratio; prognosis