Assessment as a Prognostic Marker by Meta-analysis of the Neutrophil/Lymphocyte Ratio in Acute Stroke

Background: Certain markers of inflammatory response are emerging in many studies as prognostic factors in pathological processes with an inflammatory basis, such as acute stroke. The objective of this paper is to analyze the capacity of the neutrophil/lymphocyte ratio to determine the prognostic value in this pathology by a meta-analysis and systematic review of the literature.

Methods: An exhaustive bibliographical review of articles that assessed the neutrophil-lymphocyte ratio was performed for the period 1995-2018, with an evaluation by meta-analysis with subgroups (ratio value, pathological subtype and country of origin).

Results: Fifteen studies (3,857 patients from 7 countries) were included in the study. Neutrophil/lymphocyte ratios ≥ 5 were significantly related to poor survival, regardless of pathologic subtype (prediction is stronger in the ischemic processes), and origin (oriental studies are more predictive).

Conclusion: In this meta-analysis, elevated levels of NLR obtained in the first 24 h are associated with a worse short-term prognosis in patients with stroke (ischemic and hemorrhagic). To corroborate these results will be necessary to carry out prospective studies with large cohorts of patients. The NLR is an index that is obtained from the routine analysis in the emergency room and its cost is economic, so it could be used routinely in the initial evaluation of the prognosis of the acute stroke.


Fernando Fuertes-Guiro* and Elena Camiran-Blesa

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