Is Elevated Neutrophil-to-Lymphocyte Ratio a Predictor of Stroke in Patients with Intermediate Carotid Artery Stenosis?

J Stroke Cerebrovasc Dis. 2016 Mar;25(3):578-84. doi: 10.1016/j.jstrokecerebrovasdis.2015.10.031. Epub 2015 Dec 17.


Objective: An increased neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical prognosis in patients with cardiovascular disease. In this study, we aimed to investigate if there was a correlation between NLR and the risk of stroke in patients with intermediate carotid artery stenosis.

Methods: A total of 254 patients with a 50%-70% stenosis in the carotid artery, 115 of whom were symptomatic and 139 of whom were asymptomatic, were included in the study. Patients with a history of ischemic cerebrovascular event with or without sequelae, transient ischemic attack, and amaurosis fugax in the last 1-6 months were included in the symptomatic group of the study. The symptomatic and asymptomatic groups were compared in terms of total neutrophil count, lymphocyte count, and NLR.

Results: The total white blood cell count (WBC), neutrophil count, and NLR were found to be higher and the lymphocyte count was found to be lower in the symptomatic patients than those in the asymptomatic patients (symptomatic/asymptomatic, respectively, WBC [10(3)/mm(3)]: 9.0/8.2, neutrophil count [10(3)/mm(3)]: 6.1/5.0, NLR: 3.08/2.2, lymphocyte count [10(3)/mm(3)]: 1.9/2.2) (P < .001). The cutoff value for NLR was found to be 2.6 or higher. In the multivariate regression analysis, an NLR value of 2.6 or higher was shown to be an independent variable for carotid artery stenosis to become symptomatic.

Conclusions: NLR is increased in symptomatic intermediate carotid artery stenosis. An increased NLR value is an independent variable for carotid artery plaques to become symptomatic.

Keywords: Atherosclerosis; carotid artery stenosis; inflammation; neutrophil-to-lymphocyte ratio; stroke.

MeSH terms

  • Aged
  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnostic imaging
  • Female
  • Humans
  • Leukocyte Count
  • Logistic Models
  • Lymphocytes / pathology*
  • Male
  • Middle Aged
  • Neutrophils / pathology*
  • ROC Curve
  • Retrospective Studies
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Stroke / complications
  • Stroke / diagnostic imaging
  • Stroke / pathology*
  • Tomography Scanners, X-Ray Computed
  • Ultrasonography, Doppler