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ORIGINAL RESEARCH article

Front. Med.

Sec. Family Medicine and Primary Care

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1570630

Association of neutrophil-to-lymphocyte ratio with stroke morbidity and mortality: evidence from the NHANES 1999-2020

Provisionally accepted
Xin Xu Xin Xu 1Guoqiang Zhang Guoqiang Zhang 2,3,4Fei Liu Fei Liu 3,4,5Jingwei Zheng Jingwei Zheng 2,3,4Zhijie Jiang Zhijie Jiang 2,3,4Si Hu Si Hu 6Xudan Shi Xudan Shi 7Wei Wang Wei Wang 1Liang Xu Liang Xu 2,3,4*Zixin Wang Zixin Wang 1*
  • 1 Department of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
  • 2 Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
  • 3 Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
  • 4 State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
  • 5 Neuroscience Intensive Care Unit, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
  • 6 Department of Neurosurgery, Affiliated Huzhou FuYin Hospital of Huzhou University, Huzhou, China
  • 7 Department of Anesthesiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

The final, formatted version of the article will be published soon.

    Background: Stroke is closely linked to inflammation, with the neutrophil-to-lymphocyte ratio (NLR) emerging as a promising inflammatory marker. This study aims to investigate the association between NLR and both morbidity and mortality in stroke patients.Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2020 were analyzed, including adults with complete neutrophil and lymphocyte count records. Multivariate logistic regression was used to examine the relationship between NLR and both stroke morbidity and all-cause mortality. Restricted cubic spline regression was employed to assess potential nonlinearity in these associations. Subgroup analyses were performed to identify influencing factors.Results: After adjusting for confounders, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for stroke in the higher NLR quartiles, compared to the lowest quartile, were 1.28 (1.07-1.52) and 1.36 (1.12-1.65), respectively. The restricted cubic spline curve indicated a nonlinear positive association between NLR and stroke risk.Additionally, an elevated NLR was positively associated with an increased risk of all-cause mortality.The findings underscore the potential use of NLR in stratifying and predicting mortality risk in stroke patients, suggesting its relevance in clinical practice.

    Keywords: Cross-sectional study, Stroke, NHANES, Neutrophil-to-lymphocyte ratio, predictor

    Received: 04 Feb 2025; Accepted: 21 Mar 2025.

    Copyright: © 2025 Xu, Zhang, Liu, Zheng, Jiang, Hu, Shi, Wang, Xu and Wang. 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) or licensor 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:
    Liang Xu, Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
    Zixin Wang, Department of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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