Temporal changes in the neutrophil to lymphocyte ratio and the neurological progression in cryptogenic stroke with active cancer

Ki Woong Nam, Tae Jung Kim, Chi Kyung Kim, Heejung Mo, Han Yeong Jeong, Min Kyoung Kang, Moon Ku Han, Sang Bae Ko, Byung Woo Yoon

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10 Citations (Scopus)


Background Ischemic stroke patients with active cancer frequently experience early neurological deterioration (END); however, the predictors of END are not well studied. The neutrophil to lymphocyte ratio (NLR) has recently been described as a predictor of poor outcomes in cancer and stroke. However, its role in cancer-related stroke has not been addressed. Aim We aimed to evaluate the association between the NLR and END in cancer-related stroke patients. Methods We included 85 cryptogenic stroke patients with active cancer. END was defined as an increase ≥ 4 on the total National Institutes of Health Stroke Scale (NIHSS) score within 72 hours of admission. The NLR was calculated as the ratio of the absolute neutrophil count to the absolute lymphocyte count. We obtained the NLR during the following three periods: at admission, 1-3 days after admission (D 1-3 NLR) and 4-7 days after admission (D 4-7 NLR). Results END occurred in 15 (18%) of the 85 patients. END was significantly associated with the initial NIHSS score, infarction volume, and the D 1-3 NLR. In multivariate analysis, a higher D 1-3 NLR, measured before END events, remained an independent predictor of END [adjusted odds ratio = 2.78, 95% confidence interval = 1.09-7.08, P = 0.032]. In terms of temporal changes in the NLR, the END group showed a tendency toward temporal increase in the NLR at D 1-3 (P = 0.061) with subsequent decrements in the D 4-7 NLR (P = 0.088), while the non-END group showed no significant changes in the NLR between periods. Conclusions This study demonstrated that a higher NLR could predict END events in cryptogenic stroke patients with active cancer. However, the results should be confirmed in further large prospective studies.

Original languageEnglish
Article number0194286
JournalPloS one
Issue number3
Publication statusPublished - 2018 Mar

Bibliographical note

Funding Information:
This work was supported by the Ministry of Health and Welfare (HI 16C1078), Korea. The funding organization had no role in the study or the preparation of this report.

Publisher Copyright:
© 2018 Nam et al. This is an open ccess article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and eproduction in any medium, provided the original author and source are credited.

ASJC Scopus subject areas

  • General


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