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
[103/mm3]: 9.0/8.2, neutrophil count [103/mm3]: 6.1/5.0, NLR: 3.08/2.2, lymphocyte count [103/mm3]: 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.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier.Stroke. 2008; 39: 2396-2399
- Cardiac 64-multislice computed tomography reveals increased epicardial fat volume in patients with acute coronary syndrome.Am J Cardiol. 2011; 108: 1119-1123
- Inflammation in atherosclerosis.Arterioscler Thromb Vasc Biol. 2012; 32: 2045-2051
- Hyperlipidemia and atherosclerosis.Science. 1976; 193 (1094e100)
- High neutrophil numbers in human carotid atherosclerotic plaques are associated with ch of rupture-prone lesions.Arterioscler Thromb Vasc Biol. 2010; 30 (1842e8)
- Hyperlipidemia-triggered neutrophilia promotes early atherosclerosis.Circulation. 2010; 122: 1837-1845
- Distinct infiltration of neutrophils in lesion shoulders in ApoE-/- mice.Am J Pathol. 2010; 177: 493-500
- Neutrophil infiltration of culprit lesions in acute coronary syndromes.Circulation. 2002; 106: 2894-2900
- Monocytes and neutrophils expressing myeloperoxidase occur in fibrous caps and thrombi in unstable coronary plaques.BMC Cardiovasc Disord. 2009; 9: 27
- Expression of alpha2- macroglobulin, neutrophil elastase, and interleukin-1alpha differs in early-stage and late-stage atherosclerotic lesions in the arteries of the circle of Willis.Acta Neuropathol. 2007; 113: 33-43
- Increased neutrophil-platelet adhesion in patients with unstable angina.Circulation. 1996; 94: 1239-1246
- Myeloperoxidase level in patients with stable coronary artery disease and acute coronary syndromes.Eur J Clin Invest. 2008; 38: 90-96
- Involvement of intraplaque hemorrhage in atherothrombosis evolution via neutrophil protease enrichment.J Leukoc Biol. 2007; 82: 1420-1429
- Human polymorphonuclear leukocytes produce and express functional tissue factor upon stimulation.J Thromb Haemost. 2006; 4: 1323-1330
- A novel C5a receptor-tissue factor crosstalk in neutrophils links innate immunity to coagulation pathways.J Immunol. 2006; 177: 4794-4802
- Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack.Eur Rev Med Pharmacol Sci. 2013; 17: 653-657
- Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting.Am J Cardiol. 2010; 105: 186
- ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques.Eur J Vasc Endovasc Surg. 2009; 37: 1-19
- 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery.J Am Coll Cardiol. 2011; 57: 1002-1044
- Global and regional causes of death.Br Med Bull. 2009; 92 (7e32)
- Endothelial expression of a mononuclear leukocyte adhesion molecule during atherogenesis.Science. 1991; 251 (788e91)
- White blood cell count and risk of gastric cancer incidence in a general Japanese population: the Hisayama study.Am J Epidemiol. 2012; 175 (504e10)
- Elevated white blood cell count as a risk factor of coronary artery disease: inconsistency between forms of the disease.Jpn Heart J. 2003; 44 (201e11)
- Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials.Heart. 2003; 89 (1200e4)
- Association of neutrophils and future cardiovascular events in patients with peripheral artery disease.J Vasc Surg. 2005; 41 (610e7)
- The thin-cap fibroatheroma: a type of vulnerable plaque: the major precursor lesion to acute coronary syndromes.Curr Opin Cardiol. 2001; 16: 285-292
- Association of neutrophil count with microembolization in patients with symptomatic carotid artery stenosis.Atherosclerosis. 2009; 207 (519e23)
- High neutrophil numbers in human carotid atherosclerotic plaques are associated with characteristics of rupture-prone lesions.Arterioscler Thromb Vasc Biol. 2010; 30 (1842e8)
- Influence of in vivo hydrocortisone on some human blood lymphocyte subpopulations. Effect on natural killer cell activity.Scand J Immunol. 1981; 13: 573-579
- The pathophysiology and treatment of sepsis.N Engl J Med. 2003; 348: 138-150
- Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme or the early diagnosis of myocardial infarction.Ann Intern Med. 1995; 122: 335-341
- Relation of admission white blood cell count to long term outcomes after primary coronary angioplasty for acute myocardial infarction.Am J Cardiol. 2003; 91: 729-731
- Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction.Atherosclerosis. 2008; 196: 405-412
- Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome.Am J Cardiol. 2008; 102: 653-657
- Prognostic value of neutrophils in patiens with asymptomatic carotid artery disease.Atherosclerosis. 2013; 231: 274-280
- The role of platelets in ischemic stroke.Neurology. 1998; 51: 9-14
- Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the multicenter CARESS study.Circulation. 2005; 111: 2233-2240
- Non-invasive assessment of epiaortic vessels. Comparison of magnetic resonance angiography with gadolinium, spiral computerized tomography angiography, and digital angiograph.Radiol Med. 2001; 101: 48-53
Article info
Publication history
Published online: December 16, 2015
Accepted:
October 31,
2015
Received in revised form:
August 11,
2015
Received:
May 9,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.031
Copyright
Published by Elsevier Inc.
