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

Authors

  • Martina Rentauli Medical Doctor Specialist Education Program of Clinical Pathology, Faculty of Medicine, Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar
  • Liong Boy Kurniawan Department of Clinical Pathology, Faculty of Medicine, Hasanuddin University/Dr.Wahidin Sudirohusodo Hospital
  • Darwati Muhadi Department of Clinical Pathology, Faculty of Medicine, Hasanuddin University/Dr.Wahidin Sudirohusodo Hospital

DOI:

https://doi.org/10.24293/ijcpml.v25i2.1446

Keywords:

Stroke, ischemic, hemorrhagic, NLR

Abstract

Stroke is a neurologic emergency disease and the main cause of high mortality. The inflammatory process in stroke due to cell and tissue damage causes an increase of leucocyte prominently neutrophil. Neutrophil Lymphocyte Ratio (NLR) is an easy-to-measure inflammatory marker. There is only a few data of NLR in Indonesia. This study aimed to know the difference in NLR values among ischemic and hemorrhagic stroke and to find out the diagnostic NLR to differentiate ischemic and hemorrhagic stroke patients. This study was a retrospective cross-sectional study using secondary data from Medical Record of Wahidin Sudirohusodo Hospital, Makassar. Leucocyte, neutrophil, and lymphocyte first data from adult stroke diagnosed patients were taken. Data statistically analyzed and diagnostic value of  NLR was determined by Receiver Operating Curve (ROC) analysis. Total of 402 patients was enrolled, 214 (54.72%) with ischemic stroke and 182 (46.8) with hemorrhagic stroke. There was a significant NLR difference between ischemic stroke (median 7.23) and hemorrhagic stroke (median 3.65) (p<0.001). Using cut-off 5.18, ROC curve showed of (AUC) 0.730 which had a weak performance to differentiate ischemic and hemorrhagic stroke with sensitivity 67.8% and specificity 68.6%. The neutrophil-lymphocyte ratio in hemorrhagic stroke is higher than ischemic stroke. Further studies with larger and more evenly distributed samples and consideration of sampling time are a suggestion.

Downloads

Download data is not yet available.

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.

Downloads

Submitted

2019-01-21

Accepted

2019-02-13

Published

2019-04-13

How to Cite

[1]
Rentauli, M., Kurniawan, L.B. and Muhadi, D. 2019. DIAGNOSTIC VALUE OF NEUTROPHIL-LYMPHOCYTE RATIO TO DIFFERENTIATE ISCHEMIC AND HEMORRHAGIC STROKE. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 25, 2 (Apr. 2019), 180–183. DOI:https://doi.org/10.24293/ijcpml.v25i2.1446.

Issue

Section

Articles