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Neutrophil to Lymphocyte Ratio (NLR) and Risk of First Episode Stroke in Patients with Atrial Fibrillation: A Cohort Study.
J Thromb Haemost. 2015 May 18;
Authors: Saliba W, Barnett-Griness O, Elias M, Rennert G
Abstract
BACKGROUND: Neutrophil to lymphocyte ratio (NLR) is associated with increased risk of cardiovascular morbidity and mortality. We aimed to assess the association between NLR and first episode stroke in patients with atrial fibrillation.
METHODS: Using the computerized database of the largest HMO in Israel, we identified a cohort of adults 20 years old or older with atrial fibrillation diagnosed before 1(st) January 2012. Eligible subjects had no prior stroke or TIA, were not on anticoagulants at baseline, and had at least one blood cell count performed in 2011. The cohort (32,912 subjects) was followed for the first event of stroke or TIA until 31(st) December 2012.
RESULTS: Overall 981 subjects developed stroke during 30,961 person-years follow up, (stroke rate, 3.17 per 100 person-years). Stroke incidence rate increased across NLR quartiles; 2.27, 2.72, 3.26, and 4.54 per 100 person-years, respectively. Cox proportional hazard regression analysis adjusting for the individual CHA2 DS2 -VASc score risk factors showed that, compared to the lowest NLR quartile, the HR for stroke was 1.11 (95% CI, 0.91-1.35), 1.25 (1.03-1.51), and 1.56 (1.29-1.88) for the second, third, and highest quartile, respectively. On stratified analysis, NLR refined the risk of stroke across all CHA2 DS2 -VASc score strata. Adding NLR to CHA2 DS2 -VASc score increased the AUC from 0.627 (95% CI, 0.612-0.643) to 0.635 (0.619-0.651) (P=0.037).
CONCLUSIONS: NLR is directly associated with the risk of stroke in patients with atrial fibrillation. Future studies are needed to replicate these findings. This article is protected by copyright. All rights reserved.
PMID: 25988740 [PubMed - as supplied by publisher]