COMPARISON OF ADMITTING NEUTROPHIL/LYMPHOCYTE RATIO WITH BASELINE NIH STROKE SCALE SCORE IN DISCRIMINATING POOR 30-DAY STROKE OUTCOME AMONG NIGERIAN AFRICANS

Oladotun Victor Olalusi ^1* Joseph Yaria ¹ Akintomiwa Makanjuola ¹ Rufus Olusola Akinyemi ² Mayowa Ojo Owolabi ² Adesola Ogunniyi ²

• ¹ University College Hospital Ibadan, Ibadan, Nigeria
• ² College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria

Aim: The National Institutes of Health Stroke Scale (NIHSS) score is an established marker of stroke severity. It is time-consuming and requires formal training for optimal results. In contrast, the NLR, known to be independently associated with stroke outcome, can be readily calculated from routine peripheral blood counts with minimal training. We hypothesized that the NLR may perform similarly to the NIHSS score, in discriminating persons with poor 30day stroke outcome, in a low-resource setting.Methods: We followed up 106 participants with clinico-radiologic diagnosis of first-ever acute ischemic stroke (AIS). Patients with clinico-laboratory features of fever, aspiration pneumonia, sepsis or infection were excluded at baseline. The NLR was obtained at admission while the functional outcome was assessed using the modified Rankin Scale (mRS) score at day 30.Receiver Operating Characteristics curve and Cox Proportional Hazard were used to determine the discriminatory ability of the NLR compared with the NIHSS score in identifying patients with poor 30-day stroke outcome (mRS>3). The respective AUCs and HRs (95%CI) were documented.Results: The median (IQR) NLR of the study population was 2.87 (3.0). Patients in the higher tertiles of NLR had higher mean (SD) 30-day mRS scores of 4.9 (1.2) compared to the middle 3.3 (1.2) and lower tertiles 2.3 (1.2) (p<0.001). Admitting NLR had an AUC (95% CI) of 0.83 (0.75-0.91) and HR (95%CI) of 1.19 (1.01 -1.40) compared to admitting NIHSS score with AUC: 0.89 (0.84 -0.95) and HR: 1.25 (1.14 -1.37) respectively, in discriminating poor 30day outcome.The NLR alone performed similarly to the NIHSS score and may help identify patients with adverse 30-day AIS outcome in low-resource settings.