Article · PubMed · April 1, 2026

NEUTROPHIL-TO-LYMPHOCYTE RATIO AS A POTENTIAL PREDICTOR OF IN-HOSPITAL MORTALITY AMONG ISCHEMIC STROKE PATIENTS: A PROSPECTIVE COHORT STUDY.

Zh Urasheva, A Khamidulla, Aigul P. Yermagambetova, Кабдрахманова Гульнар Баяновна, A M Grjibovski

Abstract

BACKGROUND: Ischemic stroke is a major cause of death and disability worldwide. Recent evidence highlights the role of systemic inflammation in stroke pathophysiology and prognosis. The neutrophil-to-lymphocyte ratio (NLR), an accessible biomarker from routine blood tests, has been shown to be associated with stroke severity and outcome, but more research is needed to corroborate these findings. OBJECTIVE: To study the association between NLR at admission and stroke severity and probability of death in patients with acute ischemic stroke. METHODS: This prospective cohort study included 241 patients with confirmed ischemic stroke admitted to a regional hospital in Aktobe, Kazakhstan. Neurological status was assessed using the NIH Stroke Scale (NIHSS), Modified Rankin Scale (mRS), and Glasgow Coma Scale (GCS) on days 1 and 10. NLR was calculated from admission blood tests. Due to skewed distributions, data were presented as medians (Q1; Q3), and non-parametric tests were applied. Multivariable logistic regression analysis was performed to assess factors associated with in-hospital mortality, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) reported. RESULTS: The median NLR at admission was 2.67 (1.85; 4.36). Patients who died during hospitalization had significantly higher NLR values compared to survivors (4.73 [2.30; 8.91] vs. 2.50 [1.83; 3.77]; p<0.001). Higher NLR was associated with greater stroke severity and poorer functional outcomes, reflected by higher NIHSS and mRS scores on days 1 and 10. In multivariable analysis, log-transformed NLR was associated with 50% greater odds of in-hospital mortality; however, this association did not reach statistical significance (p=0.142). CONCLUSION: Elevated NLR at admission is associated with more severe neurological deficits, worse functional outcomes, and in-hospital mortality in unadjusted analyses. Although NLR was not an independent predictor in multivariable analysis, it needs to be further studied as a simple and cost-effective potential additional biomarker for early risk stratification in acute ischemic stroke. Further large-scale, multicenter studies are needed to clarify the prognostic value of NLR in clinical practice.

Inflammatory Biomarkers in Disease PrognosisAcute Ischemic Stroke ManagementSepsis Diagnosis and Treatmentneutrophil-to-lymphocyte ratioischemic strokein-hospital mortality

NEUTROPHIL-TO-LYMPHOCYTE RATIO AS A POTENTIAL PREDICTOR OF IN-HOSPITAL MORTALITY AMONG ISCHEMIC STROKE PATIENTS: A PROSPECTIVE COHORT STUDY.

Abstract

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