Jing Wang,1,* Yan Zhao,2,* Cunming Lv,3,* Feng Li1 

1Department of Neurology, Lu’an Municipal People’s Hospital, Lu’an, People’s Republic of China; 2Department of Neurology, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing, People’s Republic of China; 3Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College, China Three Gorges University, Yichang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Feng Li, Department of Neurology, Lu’an Municipal People’s Hospital, No.21 Wanxi West Road, Jin’an District, Lu’an, Anhui Province, People’s Republic of China, Email lif0616@163.com

Background: Neutrophil-to-lymphocyte ratio (NLR) and Lymphocyte-to-monocyte ratio (LMR) have been reported to be associated with outcomes in acute ischemic stroke. However, research on elderly populations remains relatively scarce. We investigated the prognosis of NLR and LMR in elderly with acute ischemic stroke(AIS).
Methods: Based on the modified Rankin Score (mRS) on the 90th day after stroke, patients were divided into group and bad prognosis groups. Multivariate logistic regression analysis and receiver operating curves were used to identify prognostic factors and their predictive powers.
Results: In total, 824 elderly patients with AIS were enrolled between November 2021 and December 2023. Significant differences emerged in the NLR, LMR, and lymphocyte count between the two groups (P< 0.05). Binary logistic regression identified NLR, LMR and neutrophil count as independent risk factors for an unfavorable prognosis in elderly patients with AIS. The areas under the curve (AUCs) of NLR, LMR, and the combination of NLR and LMR to discriminate poor function prognosis were 0.703, 0.672, and 0.706, respectively. ROC analysis also showed that combination of NLR and LMR was superior to NLR and LMR alone for predicting AIS.
Conclusion: NLR and LMR independently contribute to an unfavorable prognosis in elderly patients with AIS. The area under the ROC curve (AUC) for the combined NLR and LMR was higher than that for NLR and LMR individually, suggesting that combining these two indicators can improve the predictive ability for clinical outcomes in elderly patients with AIS.

Keywords: neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio, acute ischemic stroke, elderly patients