Abstract Details

Title Baseline Neutrophil/Lymphocyte Ratio and Severity of Acute Stroke among Indigenous West Africans: Insights from the SIREN Multi-center Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S44 - Evidence-based Stroke Interventions and Prognostic Tools (2:48 PM-3:00 PM)

Poster/Presentation
Number 010

Objective We determined the relationship between neutrophil-lymphocyte ratio (NLR) and stroke severity

Background NLR is an important biomarker for risk stratification in acute stroke care, however, there is uncertainty regarding its applicability and translation into practice among Indigenous West Africans known to have benign neutropenia and severe stroke.

Design/Methods

Stroke was confirmed using neuroimaging. Severe stroke was defined as NIHSS score>15 and Stroke levity Scale (SLS) score≤5, while NLR was obtained at admission. Stroke population was divided into tertiles and baseline clinical characteristics compared. Spearman correlation [Rho(ρ)] was used to test the relationship between NLR and stroke severity markers. A multivariate logistic regression model was constructed to determine the relationship between NLR and stroke severity. An ROC curve was used to identify NLR thresholds that best discriminated severe stroke

Results A total of 3684 controls and 3684 stroke cases were included [mean(SD)age 59.47(14.02), 52% males]. The median(IQR) NLR among study participants was: controls 0.8(0.5); cases 2.9(3.9) - ischemic stroke (IS) 2.4(3.1), intracerebral hemorrhage (ICH) 3.9(5.0), p<0.001. Of the stroke participants, 1248 (39.2%) and 1741 (49.7%) had severe stroke using NIHSS>15 and SLS≤5 respectively. There was a significant correlation between NLR and NIHSS score (ρ 0.29,p<0.001), NLR and SLS score (ρ -0.21,p<0.001). Baseline NLR [aOR,(95% CI)] was independently associated with severity of IS 1.06(1.03–1.08), but not ICH 1.00(0.99–1.01). NLR thresholds (sensitivity, specificity) of 3.0 (60.8%,61%) – overall; 3.98 (61.9%, 60.8%) – ICH; and 2.51 (60.2%,59.4%) – IS were observed to significantly discriminate participants with severe stroke, with an AUC (95% CI) of 0.65(0.62–0.67), 0.65(0.61–0.70), 0.63(0.60–0.66), respectively.

Conclusions We established an NLR threshold unique to West Africans and observed that baseline NLR is independently associated with severity of IS, but not ICH. Our findings emphasize the role of immune-inflammatory processes in IS pathobiology and may have implications for stroke care in settings with limited access to thrombolytic therapy.

Authors/Disclosures
Oladotun V. Olalusi, MBBS (John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine) PRESENTER	Dr. Olalusi has nothing to disclose.
Zoe Williams, MD	Dr. Williams has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Dompe.
Reginald Obiako, MD, MBBS, PhD	Prof. Obiako has nothing to disclose.
Morenikeji Komolafe, MD (Obafemi Awolowo University)	Dr. Komolafe has nothing to disclose.
Godwin O. Osaigbovo, MD (Jos University Teaching Hospital, Jos)	No disclosure on file
Godwin I. Ogbole, MD	Prof. Ogbole has nothing to disclose.
Oyedunni Arulogun, PhD	Prof. Arulogun has nothing to disclose.
Carolyn Jenkins (Medical University of South Carolina)	No disclosure on file
Fred Sarfo	Fred Sarfo has nothing to disclose.
Kolawole W. Wahab, MD, FAAN (University of Ilorin Teaching Hospital)	Dr. Wahab has nothing to disclose.
Lukman F. Owolabi, PhD, MSc, FWAPC, FMCP (Bayero University)	Dr. Owolabi has nothing to disclose.
Joshua Akinyemi, PhD	Prof. Akinyemi has nothing to disclose.
Albert K. Akpalu, MD (School of Medicine and Dentistry)	Dr. Akpalu has nothing to disclose.
Rufus O. Akinyemi, MD (Institute for Advanced Medical Research and Training)	Dr. Akinyemi has nothing to disclose.
Bruce I. Ovbiagele, MD, MSc, FAAN (San Francisco VA)	Dr. Ovbiagele has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Stroke Association. Dr. Ovbiagele has received research support from National Institutes of Health. Dr. Ovbiagele has a non-compensated relationship as a President with Society for Equity Neuroscience that is relevant to AAN interests or activities. Dr. Ovbiagele has a non-compensated relationship as a Board Member with World Stroke Organization that is relevant to AAN interests or activities.
Adesola Ogunniyi, MD	Dr. Ogunniyi has nothing to disclose.
Mayowa Owolabi, MD, FAAN (Neurology Unit, Dept of Med, UCH)	Dr. Owolabi has nothing to disclose.

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