Elevated Neutrophil to Lymphocyte Ratio Predicts In-hospital Mortality Among Stroke Patients in a Metropolitan hospital in Australia, Universal Value-added measure in Stroke Care

Neutrophil counts (innate immunity) and lymphocyte counts (adaptive immunity) are common markers of inflammation in the context of acute stroke, and Neutrophil lymphocyte ratio (NLR) is likely to be expected to predict the post-stroke outcome. This study aimed to explore the predictive value of NLR to predict the very early mortality during the acute hospital admission (death within the first week of hospital stay) as this has management implications for the ongoing investigations, family discussions and resource allocation. This the first such study attempting at exploring the role of NLR in hyperacute in-patient mortality in the world to the best of our knowledge. This retrospective study included 120 patients (60 acute stroke patients who died within the first week of the hospital stay and 60 age, sex-matched controls who were discharged within two weeks of the hospital admission, alive. We reviewed the total white cell counts of these patients (first 72 hours of the hospital admission) and NLR was calculated manually. While there was no statistically significant difference between mean neutrophil counts and mean lymphocyte counts between the two cohorts [neutrophil counts (mean, SD), 8.52(3.20) in the death cohort, 6.48(2.20) among survivors and lymphocyte (mean, SD), 1.83(1.48) in the death cohort,1.66 (0.69) among survivors], there was a statistically significant difference in NLR between the two cohorts. NLR (mean, SD) was 6.51 (4.98) in the death cohort while the survivors had mean NLR of 4.64 with an SD 2.90 with a p-value of 0.048. Hypertension, diabetes, atrial fibrillation, previous vascular events were common in both groups indicating the value of exploring the evidence of background compromised vascular system and metabolic syndrome and bringing the systems biology approach to the management of stroke.