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Lymphocyte-to-monocyte ratio on day 7 is associated with outcomes in acute ischemic stroke

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Abstract

The main features of stroke-induced immunosuppression are lymphopenia and deactivation of monocytes in peripheral blood. We hypothesized that lymphocyte-to-monocyte ratio (LMR) in peripheral blood may represent the degree of stroke-induced immunosuppression. To prove this hypothesis, we evaluated whether LMR is associated with risk of post-stroke infection and clinical outcome at 3 months in patients with acute ischemic stroke. We selected patients with stroke in anterior circulation within 24 h from onset. Peripheral blood sampling for differential blood count was performed on days 1 and 7. The LMRs on days 1 and 7 were analyzed to determine associations with excellent outcomes (modified Rankin Scale of score 0–1 at 3 months). One hundred and two patients were included. The initial National Institutes of Health Stroke Scale score (adjusted odd ratio [OR] 0.89; 95% confidence interval [CI], 0.83–0.95; P = 0.001) and LMR on day 7 (adjusted OR 1.49; 95% CI, 1.09–2.02; P = 0.011) were associated with excellent outcomes. LMRs on day 1 were significantly lower in stroke patients with pneumonia (P = 0.007) and pneumonia or urinary tract infection (P = 0.012) than those without infections. LMRs on day 7 were also significantly lower in stroke patients with infection (P = 0.005 in pneumonia, P = 0.003 in urinary tract infection, and P < 0.001 in pneumonia or urinary tract infection) than those without infections. Lower LMRs on day 7 are associated with worse outcomes at 3 months after stroke onset. LMR may be a useful marker for assessing the stroke-induced immunosuppression.

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Acknowledgements

We sincerely thank Chang O Son for proofreading.

Funding

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2015R1D1A3A01019331).

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Authors and Affiliations

  1. Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan Hospital, 20 Geumo-ro, Mulgeum, Yangsan, 50612, Republic of Korea

    Min-Gyu Park, Min-Kyeung Kim, Song-Hwa Chae, Hyung-Keun Kim & Kyung-Pil Park

  2. Department of Statistics, Hallym University, Chuncheon, Gangwon, Republic of Korea

    Junhee Han

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  1. Min-Gyu Park
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Correspondence to Kyung-Pil Park.

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Park, MG., Kim, MK., Chae, SH. et al. Lymphocyte-to-monocyte ratio on day 7 is associated with outcomes in acute ischemic stroke. Neurol Sci 39, 243–249 (2018). https://doi.org/10.1007/s10072-017-3163-7

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