Abstract DP320: Elevated Neutrophil-to-Lymphocyte Ratio Does Not Predict Early Neurological Deterioration in Patients with Acute Lacunar Infarct

Introduction: Lacunar infarct, caused by occlusion of small penetrating arteries, accounts for ~25% of ischemic strokes. Despite mild initial symptoms, up to 30% of patients develop early neurological deterioration (END) within 72 hours. While the mechanisms underlying END remain unclear, inflammation is thought to contribute. The neutrophil-to-lymphocyte ratio (NLR), a well-studied inflammatory biomarker, has been linked to END in other stroke subtypes. Several studies from Southeastern Asia have explored this association in lacunar infarcts; however, data from North American populations remain scarce. We investigated this association in patients admitted to our tertiary care center. Methods: We retrospectively analyzed patients with lacunar infarcts due to cerebral small vessel disease admitted between 2020 and 2024 with available NLR data within 24 hours of presentation. Clinical, laboratory, and imaging data were extracted from institutional registries. END was defined as a ≥2-point increase in NIHSS score within 72 hours, excluding other causes. An NLR >3 was considered elevated. Group comparisons used chi-square tests for categorical variables and t-tests or Mann–Whitney U tests for continuous variables, depending on distribution. Variables with p < 0.10, along with age and sex, were entered into multivariate logistic regression to identify independent predictors of END. Results: Among 214 patients (41.1% female; mean age: 65.34 ± 13.65 years), 45 (21%) experienced END. Elevated NLR was present in 102 patients (48%). END was associated with larger infarct volume (median ± IQR: 0.28 ± 0.43 vs. 0.44 ± 0.94 cm3, p = 0.04), but not with elevated NLR (34.9% vs. 28.9%, p = 0.48) or absolute NLR values (2.42 ± 2.03 vs. 2.34 ± 1.46, p = 0.75) (Table 1). In multivariate analysis, elevated NLR was not significantly associated with END (aOR 0.68, 95% CI: 0.31–1.45, p = 0.32), whereas infarct volume remained an independent predictor (aOR 2.05, 95% CI: 1.18–3.57, p = 0.02) (Table 2). Conclusion: In this single-center cohort with lacunar infarcts, elevated NLR was not significantly associated with END. While NLR is relevant in other stroke subtypes, its predictive value in lacunar infarction appears limited. These findings underscore the need to explore alternative mechanisms and novel inflammatory biomarkers to better predict and prevent END. Notably, infarct volume was independently associated with END, highlighting its potential role in early risk stratification.