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ORIGINAL RESEARCH article

Front. Neurol.

Sec. Neurological Biomarkers

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1473802

J-shaped association of Neutrophil-to-lymphocyte ratio (NLR) with all-cause mortality and linear association with cardiovascular mortality in stroke survivors

Provisionally accepted
  • 1 Department of Neurology, Qingtian People's Hospital, zhejiang, China
  • 2 Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, China
  • 3 Department of Neurology, The First Affiliated Hospital Of China Medical College, Shenyang, China
  • 4 Department of Neurology, Shenyang First People’s Hospital, Shenyang, China
  • 5 Department of Neurology, Yuhuan Second People’s Hospital, Yuhuan, China

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

    The correlation between systemic inflammation and stroke has been well-established. Notably, the neutrophil-to-lymphocyte ratio (NLR) has been linked to poor outcomes and increased short-term mortality in acute ischemic stroke (AIS). This study aims to explore the association between NLR and long-term mortality among stroke survivors.This study analyzed data from 1,229 stroke survivors enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. The participants were categorized according to quartiles of NLR level. Multivariate Cox regression and restricted cubic splines (RCS) were applied to evaluate the relationship between NLR and all-cause and cardiovascular disease (CVD) mortality.Over a median follow-up of 6.41years, 485 deaths were recorded. After multivariate adjustment, individuals in the highest NLR quartile (Q4) demonstrated significantly higher risks of all-cause mortality (hazard ratio [HR] = 1.58, 95% confidence interval [CI]: 1.06-2.34) and CVD mortality (HR = 1.90, 95% CI: 1.07-3.37) compared to those in the lowest quartile (Q1). RCS analysis revealed a J-shaped relationship between NLR and all-cause mortality and a linear relationship with CVD mortality.These findings suggest a J-shaped association between NLR and all-cause mortality, along with a linear relationship between NLR and CVD mortality in stroke survivors.

    Keywords: J-shaped, stroke survivors, All-cause mortality, Cardiovascular mortality, Neutrophil-to-lymphocyte ratio

    Received: 03 Oct 2024; Accepted: 14 Feb 2025.

    Copyright: © 2025 Chen, Lv, Lin, Meng, Sui and Chen. 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:
    Yi Sui, Department of Neurology, The First Affiliated Hospital Of China Medical College, Shenyang, China
    Shiqin Chen, Department of Neurology, Yuhuan Second People’s Hospital, Yuhuan, 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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