Neutrophil to lymphocyte ratio at admission for identification of large artery atherosclerosis and small vascular occlusion in patients with minor stroke

Objective To investigate the differential effect of neutrophil to lymphocyte ratio (NLR) at admission on large artery atherosclerosis (LAA) and small vessel occlusion (SVO) in patients with minor stroke. Methods Patients with first-ever acute ischemic stroke registered in Nanjing Stroke Registration System were enrolled retrospectively. Minor stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤3. Binary logistic regression was used to evaluate the independent relationship between NLR and LAA. Results A total of 417 patients with minor stroke were included, of which 242 were in a LAA group and 175 were in a SVO group. Univariate analysis showed that there were significant differences in leukocyte count, neutrophil count, lymphocyte count, NLR, glycosylated hemoglobin, high-density lipoprotein cholesterol, onset to treatment time, and onset to NLR detection time between the patients of the LAA group and the SVO group (all P<0.05). Binary logistic regression analysis suggested that after adjusting for sex and high-density lipoprotein cholesterol, NLR (with the highest quartile as a reference, the first quartile: odds ratio [OR] 0.207, 95% confidence interval [CI] 0.089-0.482; P<0.001; the second quartile: OR 0.277, 95% CI 0.122-0.625, P=0.002; the third quartile: OR 0.456, 95% CI 0.197-1.057; P=0.067), onset to NLR detection time (OR 1.216, 95% CI 1.038-1.424; P=0.015), and glycosylated hemoglobin (OR 1.414, 95% CI 1.142-0.751; P=0.002) were independently associated with LAA. The area under the ROC curve of NLR predicting the LAA was 0.611 in patients admitted within 7 d after onset, and was 0.673 in patients admitted within 24 h after onset. Conclusions The increased NLR was independently associated with the LAA in patients with minor stroke. Early NLR value may have higher predictive value for LAA. Key words: Stroke; Brain Ischemia; Severity of Illness Index; Neutrophils; Lymphocytes; Atherosclerosis; Cerebral Small Vessel Diseases; Risk Factors