Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

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Association of lymphocyte to monocyte ratio to cognitive impairment after acute ischemic stroke and transient ischemic attack: a multicenter cohort study

First author：左丽君,Dong Yanhong

Corresponding author：李子孝

post stroke cognitive impairment hemoglobin albumin lymphocyte platelet

essential_information

2024-01-10

Published articles

Journal：journal of inflammation

Publication type: Article

IF(IF): 3.2

PMID: 38223135 Link To Pubmed Full text Download

Background And Purpose

神经炎症活性增加与精神和行为异常综合征有关。系统性炎症反应增加与认知障碍发生相关。越来越多研究发现神经免疫炎症在缺血性卒中病理中发挥重要作用。最易评定外周免疫的一般方法是血液分化白细胞的计数。此外，这些测量的比值包括中性粒细胞/淋巴细胞比值(Neutrophil to lymphocyte ratio,NLR)，血小板/淋巴细胞比(platelet to lymphocyte ratio,PLR)，全身免疫炎症指标(systemic immune-inflammation index,SII)和淋巴细胞/单核细胞比率(LMR)的变化能更好地反映外周免疫强度。最近研究报道NLR,PLR及淋巴细胞与单核细胞比值(lymphocyte to monocyte ratio,LMR)可作为基线炎症过程的新型生物标志物，也是缺血性脑卒中的重要预测指标。NLR、PLR和LMR急性缺血性卒中静脉溶栓后神经功能恶化的预测因子。急性期的NLR升高与卒中后3个月PSCI相关，但是样本量较小。另有研究发现，LMR的动态变化与心血管术后认知功能障碍发生相关。目前研究尚无LMR与PSCI的关系的研究。

Method

Methods: We recruited 1022 participants with AIS/TIA in this study from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). The HALP score was computed by the formula: hemoglobin (g/L)×albumin (g/L)×lymphocytes (/L) / platelets (/L), and was split into four layers according to the tertiles. They were divided into four groups according to quartiles of baseline HALP score. Patients’ cognitive functions were assessed by MoCA-Beijing at 2 weeks and at 12 months. Multiple logistic regression models were performed to evaluate the relationship between the HALP score and PSCI at 2 weeks and at 1 year follow-up.

Conclusion

Conclusions: A low HALP score was found to be correlated with long-term PSCI, but we have not found short-term effect on PSCI. HALP score may aid in the early detection for PSCI.

Main results

Results: Cognitive impairment was defined as MoCA-Beijing ≤22. Most patients were in 60s (61.59±11.00 years old) with a median (interquartile range) National Institute of Health Stroke Scale score of 3.00(4.00). They also had greater than primary school level of education. Approximately three quarter of patients were male (n=746, 72.99%). The HALP score was divided into quartiles, i.e. four layers: Q1≤36.56, Q2 = 36.56-48.83, Q3 = 48.83-65.08 and Q4≥65.08, respectively. the incidence of PSCI at 2 weeks was 49.21%. Among the 1022 participants, 331 participants (32.39%) patients suffered PSCI at 1 year follow-up. The Q1 layer showed the highest risk of 12-month PSCI after adjusting for confounding factors [(odds ratio (OR)=1.59, 95% confidence interval (CI)= 1.07~2.37, p=0.022)]. Patients with the lowest HALP score, i.e., Q1, showed significantly lower MoCA subtest domain scores for executive function, naming and attention.