title: Is Elevated Neutrophil-to-Lymphocyte Ratio a Predictor of Stroke in Patients with Intermediate Carotid Artery Stenosis?
abstract: OBJECTIVE
  An increased neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical prognosis in patients with cardiovascular disease. In this study, we aimed to investigate if there was a correlation between NLR and the risk of stroke in patients with intermediate carotid artery stenosis.
  
  
  METHODS
  A total of 254 patients with a 50%-70% stenosis in the carotid artery, 115 of whom were symptomatic and 139 of whom were asymptomatic, were included in the study. Patients with a history of ischemic cerebrovascular event with or without sequelae, transient ischemic attack, and amaurosis fugax in the last 1-6 months were included in the symptomatic group of the study. The symptomatic and asymptomatic groups were compared in terms of total neutrophil count, lymphocyte count, and NLR.
  
  
  RESULTS
  The total white blood cell count (WBC), neutrophil count, and NLR were found to be higher and the lymphocyte count was found to be lower in the symptomatic patients than those in the asymptomatic patients (symptomatic/asymptomatic, respectively, WBC [10(3)/mm(3)]: 9.0/8.2, neutrophil count [10(3)/mm(3)]: 6.1/5.0, NLR: 3.08/2.2, lymphocyte count [10(3)/mm(3)]: 1.9/2.2) (P < .001). The cutoff value for NLR was found to be 2.6 or higher. In the multivariate regression analysis, an NLR value of 2.6 or higher was shown to be an independent variable for carotid artery stenosis to become symptomatic.
  
  
  CONCLUSIONS
  NLR is increased in symptomatic intermediate carotid artery stenosis. An increased NLR value is an independent variable for carotid artery plaques to become symptomatic.
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey. Electronic address: drerkankoklu@gmail.com.
authors.forename: Erkan
authors.initials: E
authors.lastname: Köklü
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: İsa Öner
authors.initials: İÖ
authors.lastname: Yüksel
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Şakir
authors.initials: Ş
authors.lastname: Arslan
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Nermin
authors.initials: N
authors.lastname: Bayar
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Göksel
authors.initials: G
authors.lastname: Çağırcı
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Elif Sarıönder
authors.initials: ES
authors.lastname: Gencer
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Ahmet Şükrü
authors.initials: AŞ
authors.lastname: Alparslan
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Çay
authors.affiliation: Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Görkem
authors.initials: G
authors.lastname: Kuş
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D015898:Tomography Scanners, X-Ray Computed; D018608:Ultrasonography, Doppler
keywords: Atherosclerosis; carotid artery stenosis; inflammation; neutrophil-to-lymphocyte ratio; stroke