Predictive Value of Circulating Inflammatory Biomarkers in Earlyonset Post-stroke Cognitive Impairment: A Prospective Cohort Study

Weiquan Huang ¹ Libin Liao ¹ Qian Liu ² 荣超 马 ¹ Wentong Hu ¹ Yuan Dai ² Luna Wang ² DUJUAN SHA ^2,3*

• ¹ Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Liaoning Province, China
• ² Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
• ³ Other, Nanjing, China

Stroke ranks as the second leading cause of mortality and the third leading cause of disability globally. Post-stroke cognitive impairment (PSCI) is a prevalent complication following acute ischemic stroke, imposing substantial burdens on patients, families, and society. This study aimed to explore the potential of circulating immune-inflammatory markers as predictors of PSCI. Conducted as a prospective observational cohort study from June 2023 to August 2024 at the Affiliated Drum Tower Hospital, Medical School of Nanjing University, it included patients experiencing their first acute ischemic stroke within 72 hours of symptom onset. Cognitive assessments were conducted 7 to 10 days post-stroke using the Montreal Cognitive Assessment (MoCA), with scores below 23 indicating PSCI. A total of 146 patients meeting the inclusion criteria were recruited, with 71 patients exhibiting PSCI during the acute stroke phase. Compared to patients in the post-stroke no cognitive impairment (PSNCI) group, those with PSCI demonstrated significantly elevated peripheral blood neutrophil-lymphocyte ratio (NLR), globulin-lymphocyte ratio (GLR), and C-reactive protein-lymphocyte ratio (CLR), while the lymphocyte-monocyte ratio (LMR) was notably reduced (all p<0.05). Both univariate and multivariate logistic regression analyses identified GLR as independently associated with PSCI. After adjusting for common clinical variables, the odds ratio (OR) for the highest tertile of GLR compared to the lowest was 6.20 (95% CI, 2.10-18.33; p=0.001). The optimal GLR cutoff was 18.22, with a sensitivity of 62.0%, specificity of 78.7%, and an area under curve (AUC) of 0.726. This study indicates that elevated circulating GLR levels during the acute phase post-stroke onset are an independent risk factor for early-onset PSCI, even after adjusting for clinically relevant variables.