The relationship between lymphocyte / monocyte ratio and short-term mortality in acute ischemic stroke patients.
Öz
Objective:The
lymphocyte / monocyte ratio (LMR) obtained by dividing the number of
lymphocytes by monocyte number is considered a new marker of
inflammation.Recent studies have found an inverse relationship between LMR
levels and 3-month functional recovery after acute ischemic stroke (AIS).Our
aim in this study is to determine the role of LMR in the short-term mortality
of AIS patients.
Method:Our study is a single centered
retrospective study. 508 patients with AIS, who presented to our clinic between
January 2011 and December 2017 and 512 healthy control with similar age and sex
were included to our study.
Results: While
monocyte count was higher in the patient group.lymphocyte count and LMR levels
were higher in the control group. The patient group was then divided into two
subgroups according to 30-day mortality. When the patients in the first group
survivied (n = 396), the patients in the second group diedwithin 30 days after
AIS(n = 112).In the second group, the lymphocyte count and LMR levels were lower
when the monocyte count was elevated (p < 0.001).Logistic regression
analysis showed that uric acid, CRP and LMR are independent variables for the
occurrence of 30-day mortality. In addition, ROC analysis revealed that an LMR value below 2.95 can be used as
a marker for the short-term mortality of AIS(AUC:0.77, %95 CI:0.67-
0.86,sensitivity:%72.6,specificity:%80.7).
Conclusion: Based on
our results, it can be concluded that lower LMO levels in patients with AIS are
related to short-term mortality.
Anahtar Kelimeler
white blood cell subtypes lymphocyte/ monocyte ratio inflammation mortality
Kaynakça
- 1.Bolayir A,Gokce SF, Cigdem B, Bolayir HA, Kayim Yildiz O,Bolayir E,et al. Monocytes/high-density lipoprotein ratio predicts the mortality in ischemic stroke. Neurologia i Neurochirurgia Polska 2018; 55: 150-155.
- 2. Rodrigues SF, Granger DN. Leukocyte-mediated tissue injury in ischemic stroke. Curr Med Chem, 2014; 21: 2130–2137.
- 3.Kim J, Song TJ, Park JH, Lee HS, Nam CM, Nam HS, et al. Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis, 2012; 222: 464–467.
- 4. Pagram H, Bivard A, Lincz LF, Levi C. Peripheral immune cell counts and advanced imaging as biomarkers of stroke outcome. Cerebrovasc Dis Extra, 2016; 6: 120–128.
- 5. Liberale L, Montecucco F, Bonaventura A, Casetta I, Seraceni S, Trentini A, et al. Monocyte count at onset predicts post-stroke outcomes during a 90-day follow up. Eur J Clin Invest, 2017; 47(10): 702–710.
- 6.Zhu JY, Liu CC, Wang L, Zhong M, Tang HL, Wang H. Peripheral bloodlymphocyte-to-monocyte ratio as a prognostic factor inadvanced epithelial ovarian cancer: a multicenterretrospective study. J Cancer 2017;8:737-743.
- 7. Song W, Tian C, Wang K, Zhang RJ, Zou SB. The pretreatmentlymphocyte to monocyte ratio predicts clinical outcomefor patients with hepatocellular carcinoma: a meta-analysis.Sci Rep 2017;7:466-451.
- 8. Ji H, Li Y, Fan Z, Zuo B, Jian X, Li L, et al. Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment. BMC Cardiovasc Disord 2017;17:90- 95.
- 9.Ren H, Liu X, Wang L,Gao Y. Lymphocyte-to-monocyte ratio: a novel predictor of the prognosis of acute ischemic stroke. Journal of Stroke And Cerebrovascular Diseases 2017; 26(11): 2595–2602.
- 10.Bolayir A,Cigdem B, Gokce SF, Bolayir HA, Kayim Yildiz O,Bolayir E,et al. The Effect of Eosinopenia on Mortality in Patients with Intracerebral Hemorrhage. Journal of Stroke and Cerebrovascular Disease 2017;10(26):2248- 2255.
- 11. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
- 12. Anrather J, Iadecola C. Inflammation and stroke: an overview. Neurother 2016;13:661-670.
- 13. Bolayir A, Gokce SF. The role of mean platelet volume, platelet distrubition width and platelet/lymphocyte ration in development of cerebral venous thrombosis. Cumhuriyet Medical Journal 2017;39:683-691.
- 14.Liesz A, Suri-Payer E, Veltkamp C, Doerr H, Sommer C,Rivest S, et al. Regulatory T cells are key cerebroprotective immunomodulators in acute experimental stroke. Nat Med 2009;15:192-199.
- 15. Chiu NL, Kaiser B, Nguyen YV, Welbourne S, Lall C, Crammer SC. The volume of the spleen and its correlates after acute stroke. J Stroke Cerebrovasc Dis 2016;25:2958-2961.
- 16. Urra X, Villamor N, Amaro S, Gomez-Choco M,Obach V, Oleaga L, et al. Monocyte subtypes predict clinical course and prognosis in human stroke. J Cereb Blood Flow Metab 2009;29:994-1002.
Öz
Amaç: Lenfosit
sayısının monosit sayısına bölünmesi ile elde edilen lenfosit/ monosit
oranı(LMO) inflamasyonu göstermede yeni bir belirteç olarak kabul edilmektedir.
Son çalışmalar, LMO düzeyleri ile akut iskemik inme (Aİİ) sonrası 3 aylık fonksiyonel
iyileşme arasında ters bir ilişki olduğunu saptamıştır. Bu çalışmadaki amacımız
LMO’nun Aİİ hastalarının kısa dönem mortalitesini göstermedeki rolünü
saptamaktır.
Yöntem: Çalışmamız tek merkezli retrospektif bir çalışmadır. Ocak 2011- Aralık 2017 yılları arasında kliniğimizde Aİİ tanısı ile izlenmiş 508 hasta ile benzer yaş ve cinsiyete sahip 512 kontrol çalışmamıza dahil edildi.
Bulgular:
Monosit sayısı hasta grubunda yüksekken lenfosit sayısı ve LMO
düzeyleri kontrol grubunda yüksek saptandı. Hasta grubu daha sonra 30 günlük
mortaliteye göre iki alt gruba ayrıldı. İlk grupta hayatta kalan hastalar
varken(n=396) ikinci gruptaki hastalar Aİİ sonrası 30 gün içinde exitus
olmuştu(n=112). Bu iki grup kıyaslandığında; ikinci grupta lenfosit sayısı ve
LMO düzeyleri düşükken, monosit sayısı yüksekti ( p < 0.001). Aİİ sonrası 30
günlük mortalite ile ilişkili risk faktörlerini belirlemek için yapılan
lojistik regresyon analizi ürik asit, CRP ve LMO’nun mortalite gelişimi için
bağımsız değişkenler olduğunu ortaya koydu. Ayrıca işlem karakteristiği eğrisi analizi ile LMO
için 2.95’in altındaki değerlerin Aİİ'ye bağlı 30 günlük mortaliteyi saptamada
kullanılabileceği gösterildi (EAA:0.77, %95
GA:0.67- 0.86,duyarlılık:%72.6,seçicilik:%80.7).
Sonuç: Sonuçlarımıza
dayanarak Aİİ’li hastalardaki düşük LMO düzeylerinin kısa dönem mortalite ile
ilişkili olduğu söylenebilir.
Anahtar Kelimeler
beyaz küre alt tipleri lenfosit/monosit oranı inflamasyon mortalite akut iskemik inme;
Kaynakça
- 1.Bolayir A,Gokce SF, Cigdem B, Bolayir HA, Kayim Yildiz O,Bolayir E,et al. Monocytes/high-density lipoprotein ratio predicts the mortality in ischemic stroke. Neurologia i Neurochirurgia Polska 2018; 55: 150-155.
- 2. Rodrigues SF, Granger DN. Leukocyte-mediated tissue injury in ischemic stroke. Curr Med Chem, 2014; 21: 2130–2137.
- 3.Kim J, Song TJ, Park JH, Lee HS, Nam CM, Nam HS, et al. Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis, 2012; 222: 464–467.
- 4. Pagram H, Bivard A, Lincz LF, Levi C. Peripheral immune cell counts and advanced imaging as biomarkers of stroke outcome. Cerebrovasc Dis Extra, 2016; 6: 120–128.
- 5. Liberale L, Montecucco F, Bonaventura A, Casetta I, Seraceni S, Trentini A, et al. Monocyte count at onset predicts post-stroke outcomes during a 90-day follow up. Eur J Clin Invest, 2017; 47(10): 702–710.
- 6.Zhu JY, Liu CC, Wang L, Zhong M, Tang HL, Wang H. Peripheral bloodlymphocyte-to-monocyte ratio as a prognostic factor inadvanced epithelial ovarian cancer: a multicenterretrospective study. J Cancer 2017;8:737-743.
- 7. Song W, Tian C, Wang K, Zhang RJ, Zou SB. The pretreatmentlymphocyte to monocyte ratio predicts clinical outcomefor patients with hepatocellular carcinoma: a meta-analysis.Sci Rep 2017;7:466-451.
- 8. Ji H, Li Y, Fan Z, Zuo B, Jian X, Li L, et al. Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment. BMC Cardiovasc Disord 2017;17:90- 95.
- 9.Ren H, Liu X, Wang L,Gao Y. Lymphocyte-to-monocyte ratio: a novel predictor of the prognosis of acute ischemic stroke. Journal of Stroke And Cerebrovascular Diseases 2017; 26(11): 2595–2602.
- 10.Bolayir A,Cigdem B, Gokce SF, Bolayir HA, Kayim Yildiz O,Bolayir E,et al. The Effect of Eosinopenia on Mortality in Patients with Intracerebral Hemorrhage. Journal of Stroke and Cerebrovascular Disease 2017;10(26):2248- 2255.
- 11. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
- 12. Anrather J, Iadecola C. Inflammation and stroke: an overview. Neurother 2016;13:661-670.
- 13. Bolayir A, Gokce SF. The role of mean platelet volume, platelet distrubition width and platelet/lymphocyte ration in development of cerebral venous thrombosis. Cumhuriyet Medical Journal 2017;39:683-691.
- 14.Liesz A, Suri-Payer E, Veltkamp C, Doerr H, Sommer C,Rivest S, et al. Regulatory T cells are key cerebroprotective immunomodulators in acute experimental stroke. Nat Med 2009;15:192-199.
- 15. Chiu NL, Kaiser B, Nguyen YV, Welbourne S, Lall C, Crammer SC. The volume of the spleen and its correlates after acute stroke. J Stroke Cerebrovasc Dis 2016;25:2958-2961.
- 16. Urra X, Villamor N, Amaro S, Gomez-Choco M,Obach V, Oleaga L, et al. Monocyte subtypes predict clinical course and prognosis in human stroke. J Cereb Blood Flow Metab 2009;29:994-1002.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 5 Haziran 2018 |
| Kabul Tarihi | 15 Mayıs 2018 |
| Yayımlandığı Sayı | Yıl 2018 |