Combination of White Matter Hyperintensity and Neutrophil-to-Lymphocyte Ratio Predicts Short-Term Prognosis of Acute Ischemic Stroke Patients

Qingyan Zhang,1,2 Danyue Ma,1,2 Hebin Du,3 Tiantian Wang,3 Wei Li3 1Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, 100191, People’s Republic of China; 2Zhejiang Provincial Key Laboratory of Ultra-Weak Magnetic-Field Space and Applied Technology, Hangzhou Innovation Institute of Beihang University, Hangzhou, 310000, People’s Republic of China; 3Department of Neurology, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, 223800, People’s Republic of ChinaCorrespondence: Wei Li, Department of Neurology, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, 223800, People’s Republic of China, Tel +86-52784235896, Email [email protected]: To assess the value of combination of white matter hyperintensity (WMH) and neutrophil-to-lymphocyte ratio (NLR) in predicting short-term prognosis of acute ischemic stroke (AIS) patients.Patients and Methods: Three hundred and nine AIS patients were included in this prospective observational research. They were evaluated at 3-month after the onset of AIS using modified Rankin Scale (mRS) score. A mRS score of 0– 2 was defined as a favourable outcome, while an mRS score of 3– 6 was defined as an unfavourable outcome. Multivariate analysis was used to identify the independent associations of WMH and NLR with short-term prognosis of AIS patients, and receiver operating characteristic (ROC) curves were used to evaluate the predictive values of WMH, NLR and their combination for short-term prognosis of AIS patients, and Z test was used to compare the area under curve (AUC).Results: Among 309 AIS patients, 201 (65.0%) had a favorable 3-month outcome, while 108 (35.0%) had an unfavorable outcome. According to the results of multivariate analysis, WMH, NLR and on-admission NIHSS score were independently associated with unfavourable outcome of AIS after adjusting for diabetes mellitus, atrial fibrillation, TOAST subtype and LDL-cholesterol. ROC curves showed that the AUCs of WMH, NLR and their combination for predicting short-term prognosis of AIS patients were 0.760 [standard error (SE): 0.029, 95% confidence interval (CI): 0.703– 0.817, P< 0.001], 0.717 (SE: 0.030, 95% CI: 0.661– 0.774, P< 0.001) and 0.906 (SE: 0.019, 95% CI: 0.868– 0.944, P< 0.001), respectively. The AUC of combination prediction was significantly higher than those of individual predictions (0.906 vs 0.760, Z=4.211, P< 0.001; 0.906 vs 0.717, Z=5.322, P< 0.001).Conclusion: WMH and NLR were independently associated with short-term prognosis of AIS patients, and the combination of WMH and NLR could be applied in predicting short-term prognosis of AIS patients, having a high predictive value.Keywords: acute ischemic stroke, short-term prognosis, white matter hyperintensity, neutrophil-to-lymphocyte ratio, prediction