DIAGNOSTIC VALUE OF NEUTROPHIL-LYMPHOCYTE RATIO TO DIFFERENTIATE ISCHEMIC AND HEMORRHAGIC STROKE

Martina Rentauli, Liong Boy Kurniawan, Darwati Muhadi

Abstract


Introduction

Stroke is a neurologic emergency disease and the main cause of high mortality. Inflammatory process in stroke due to cell and tissue damage causes increase of leucocyte prominently neutrophil. Neutrophil Limphocyte Ratio is an easy-to-measure inflammatory marker. There is only few data of RNL in Indonesia.

Methods

This was a retrospective cross-sectional study using secondary data from Medical Record RSUP Wahidin Sudirohusodo, Makassar. Leucocyte, neutrophil and lymphocyte first data were taken from adult  stroke diagnosed patients. Data statistically analyzed and diagnostic value of  NLR was determined by ROC curve analysis.

Results dan Discussion

Total of 402 patients were enrolled, 214 (54.72%) with ischemic stroke and 182 (46.8) with hemorrhagic stroke. There was a significant RNL difference between ischemic stroke (median 7.23) and hemorrhage stroke (median 3.65) (p<0.001). Using cut off 5.18, ROC curve showed of AUC 0.730 which had weak perfomance to differentiate ischemic and hemorrhagic stroke with sensitivity 67.8% and specificity 68.6%.

Conclusion and Suggestion

NLR in hemorrhagic stroke is higher than ischemic stroke. We suggest further studies with larger and more evenly distributed samples and consideration of sampling time.

 


Keywords


Stroke, ischemic, hemorrhagic, NLR

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References


Warlow CP, Dennis MS, Gijn VJ, Hankey GJ, Sandercock PA, Bamford JM. Stroke, in : A Practical Guide to Management, 1st Ed., London Blackwell Science,. 2007

Gofir A. Manajemen Stroke. Evidence Based Medicine. Yogyakarta. Pustaka Cendekia Press. 2011

Departemen Kesehatan Indonesia. 8 orang dari 1000 orang di Indonesia Terkena Stroke. (Cited on 2016 June, 1st). Available at www. depkes.go.id

Clark W. Reperfusion Injury. (Cited on 2016 June 3rd). Available at www.emedicine.com/neuro

Kleinig TJ, Vink R. Suppression of inflammation in ischemic and hemorrhagic stroke: therapeutic options. Current Opinion in Neurology. 2009; 22:294–301

Gupta S, Agrawal A, Agrawal S, Su H, and Gollapudi S. A Paradox of immunodeficiency and Inflamation in Human Aging: Lesson Learned from Apoptosis. Immunology Ageing. 2006; 3:5

Hamzah SRM. Leucocyte Count in the Ischemic and Hemorrhagic Stroke Patient. Jurnal Majority 2015; 4(1)

Del Zoppo GJ, Becker K, Hallenback JM. The Role Of Inflammation In a Ischaemic Stroke. World Stroke Congress. Melbourne 2000

San I, Icme F, Yuzbasiaglu Y, Otal Y, Coskun S, Sener A, et al. The Prognostic Relationship Between Complete Blood Count Parameter adn Infarct Positive TIA, Infarct Negative TIA and Ischaemic Stroke. Acta Medica Mediterrania 2016; 32: 97

Gokhan S, Ozhansenekler A, Durgun M, Akil E, Ustundag M, Orak M. Neutrophil Lymphocyte Ratio in Stroke Subtypes and Transient Ischemic Attack. European Review for Medical and Pharmacological Sciences. 2013; 17 : 653 -57

Zahorec R. Ratio of neutrophil to lymphocyte counts– rapid and Simple parameter of systemic inflammation and stress in critically ill. Dept.of Anaesthesia and Intensive Care Medicine. Slovakia. 2001

Rukshin M, Jessani N, Medina Miriam, Blaha J, Rukshin V. The Diagnostic Value of the Neutrophil Lymphocyte Ratio in Stroke Recognition. The Columbia J.Science Journal. 2016

Alexander, Lori L. Ischaemic Stroke: CME Resource. Sacramento California. 2011

O’Donnel MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk Factor for Ischaemik and Intracerebral Haemorrhage Stroke in 22 countries (The Interstroke Study); a Case Control Study. Population Health Research Institute. Canada, 2010

Agnihotri, S., Czap, A., Staff, I., Fortunato, G., McCullough, L. Peripheral Leukocyte Counts and Outcomes after Intracerebral Hemorrhage. Journal of Neuroinflammation, 2011; 8:160-4.

Hatta, S., Ilyas, M., Murtala, B., Liyadi, F. Profil Hitung Leukosit Darah pada Fase Akut Stroke Hemoragik dan Iskemik Dihubungkan Volume Lesi pada Pemeriksaan CT Scan Kepala. Medica Nusantara, 2010; 25: 1-6.

Bain BJ, Bates M, Laffan MA. Reference Ranges and normal values. Dacie and Lewis Practical Hematology 11th Ed. Philadelphia. Churchill Livingstone. 2009:19-20

Hoffbrand A, Petit J. Essential Haematology 6th Ed. Jakarta: EGC. 2005: 1-8.




DOI: http://dx.doi.org/10.24293/ijcpml.v25i2.1446

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