Neutrophil-to-Lymphocyte Ratio Better Than High-Sensitivity C-Reactive Protein in Predicting Stroke-Associated Pneumonia in Afebrile Patients

Ti Wu,1,&ast; Haipeng Zhang,2,&ast; Xiaolin Tian,3 Yang Cao,2 Dianjun Wei,4 Xiangkun Wu4 1Department of Neurology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 2Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, People’s Republic of China; 3Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People’s Republic of China; 4Department of Clinical Laboratory, Hebei Yanda Hospital, Langfang, Hebei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiangkun Wu Tel +8615613682051Email wuxiangkun_2021@163.comPurpose: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) without fever and to clarify whether NLR has an advantage over high-sensitivity C-reactive protein (hs-CRP) in predicting SAP.Patients and Methods: A total of 434 patients with AIS without fever were assessed in this study. Multivariable analysis was used to evaluate the relationship between NLR and SAP, and the receiver operating characteristic (ROC) curve was used to compare the predictive value of NLR and hs-CRP.Results: Among the total patients, 18 (4.1%) developed SAP. After adjusting for confounders, NLR (adjusted odds ratio [aOR] = 1.60; 95% confidence interval [CI], 1.30– 1.96; p < 0.001) remained independently associated with an increased risk of SAP. In addition, the area under the curve (AUC) of NLR (0.862 [0.826– 0.893]) was higher than that of hs-CRP (0.738 [0.694– 0.779]).Conclusion: We found that compared with hs-CRP, NLR was significantly associated with the occurrence of SAP in patients with AIS without fever and showed a more effective predictive value for SAP.Keywords: stroke, pneumonia, neutrophil, lymphocyte, high-sensitivity C-reactive protein, inflammation