This article is a commentary on:
Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis
Youwei Lin MM1Qianghong Xu MM2*- 1Yuhuan Second People’s Hospital, Taizhou, China
- 2Department of Intensive Care, Zhejiang Hospital, Hangzhou, China
A Commentary on
Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis
by Gao, B. B., Pan, W. J., Hu, X. T., Huang, H. H., Ren, J. L., Yang, C. G., Zhou, X. B., Zeng, T., Hu, J. Y., Li, S. Q., Gao, Y. F., Zhang, S. K., and Chen, G. Y. (2021). Front. Physiol. 12:670323. doi: 10.3389/fphys.2021.670323
Introduction
In a recent study (Gao et al., 2021), investigated the neutrophil-related ratios in patients with acute ischemic stroke after thrombosis. After adjusting for confounders, they reported several granulocyte parameters were independently associated with 90-day outcomes. This study adds important information to the current evidence. However, several points may need to be noted when interpreting these findings.
Multicollinearity
In the multivariable logistic regression model, eight granulocyte parameters, including neutrophil ratio, neutrophil count, lymphocyte count, eosinophil count, monocyte count, neutrophil to lymphocyte ratio (NLR), neutrophil to eosinophil ratio (NER), and monocyte to neutrophil ratio (MNR), were including in the same model. In model 2, neutrophil ratio, neutrophil count, NLR, NER, and MNR were significantly associated with poor neurological outcome at 3-month (mRS 3-6). However, we should note that these granulocyte parameters may have a close relationship with each other. Simply including these parameters in the same model may increase the risk of multicollinearity (Vatcheva et al., 2016; Kim, 2019), which may lead to a biased estimation. Besides, when the results of the multivariate analyses change greatly from that of the univariate analyses (Zhang and Zhu, 2022), we suggest that multicollinearity, modulating effect, and mediation effect should be considered in addition to interacting effect.
Events per Variable
In addition, in the current study, 283 patients with AIS were included, 87 of whom had positive events (poor neurological outcome at 3 months). A total of seventeen variables were included in the multivariate logistic model, and the number of events per variable (EPV) is 87/17=5.1. However, according to Peduzzi et al.‘s finding (Peduzzi et al., 1996), the EPV less than 10 may also increase the bias risk of the regression coefficients.
Finally, this study provided important information for acute ischemic stroke, and their work is very much appreciated.
Author Contributions
YM raised the question and made a final revision. QX wrote the manuscript.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s Note
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References
Gao B., Pan W., Hu X., Huang H., Ren J., Yang C., et al. (2021). Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients after Intravenous Thrombolysis. Front. Physiol. 12, 670323. doi:10.3389/fphys.2021.670323
Kim J. H. (2019). Multicollinearity and Misleading Statistical Results. Korean J. Anesthesiol. 72, 558–569. doi:10.4097/kja.19087
Peduzzi P., Concato J., Kemper E., Holford T. R., Feinstein A. R. (1996). A Simulation Study of the Number of Events Per Variable in Logistic Regression Analysis. J. Clin. Epidemiol. 49, 1373–1379. doi:10.1016/s0895-4356(96)00236-3
Vatcheva K. P., Lee M., McCormick J. B., Rahbar M. H. (2016). Multicollinearity in Regression Analyses Conducted in Epidemiologic Studies. Epidemiol. (Sunnyvale) 6, 227. doi:10.4172/2161-1165.1000227
Keywords: granulocyte, multicollinearity, acute ischemic stroke, poor outcome, events per variable
Citation: MM YL and Xu MM Q (2022) Commentary: Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis. Front. Physiol. 13:936860. doi: 10.3389/fphys.2022.936860
Received: 05 May 2022; Accepted: 23 May 2022;
Published: 15 June 2022.
Edited by:
Jingjing Zhang, Affiliated Hospital of Guangdong Medical University, ChinaReviewed by:
Archana Hinduja, The Ohio State University, United StatesCopyright © 2022 MM and Xu MM. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Qianghong Xu MM, xqhong@163.com