Clinical study on the combined predictive value of admission neutrophil-to-lymphocyte ratio and stress hyperglycemia ratio for early neurological deterioration in acute ischemic stroke
5 affiliations
- 1Department of Emergency Medicine, West China Hospital, West China School of Nursing, Sichuan University, Sichuan University, Chengdu, 610041 China
- 2Institute of Disaster Medicine, Sichuan University, Chengdu, 610041 China
- 3Nursing Key Laboratory of Sichuan Province, Chengdu, 610041 China
- 4Department of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, 610041 China
- 5No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041 Sichuan China
Abstract
Background: Early neurological deterioration (END) affects short-term prognosis in acute ischemic stroke. Inflammation and stress-related glucose dysregulation may contribute to END, but their incremental predictive value remains unclear.
Objective: To evaluate the associations of admission neutrophil-to-lymphocyte ratio (NLR) and stress hyperglycemia ratio (SHR) with END and assess whether adding these biomarkers to clinical variables improves risk discrimination.
Methods: This single-center retrospective cohort study included 180 patients with acute ischemic stroke admitted between January 2021 and December 2024. NLR was calculated as neutrophil/lymphocyte ratio. SHR was calculated as admission glucose/estimated average glucose and rescaled as SHR_0.1 = SHR/0.1 before regression, so that the OR represented each 0.1-unit increase. END was defined as an NIHSS increase ≥ 2 within 72 h. Multivariate logistic regression and ROC analysis were performed.
Results: END occurred in 38 patients (21.1%). NLR was independently associated with END per 1-unit increase (OR = 1.193, 95% CI 1.071–1.328, P = 0.001). Rescaled SHR was independently associated with END per 0.1-unit increase (OR = 1.241, 95% CI 1.082–1.424, P = 0.002). The basic clinical model had an AUC of 0.793, whereas adding NLR and SHR increased the AUC to 0.884.
Conclusion: Admission NLR and rescaled SHR were independently associated with END. Adding these routine biomarkers to clinical variables may improve early END risk stratification, pending external validation.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12883-026-05242-4.
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BibTeX
@article{xie2026clinical,
title = {{Clinical study on the combined predictive value of admission neutrophil-to-lymphocyte ratio and stress hyperglycemia ratio for early neurological deterioration in acute ischemic stroke}},
author = {Juan Xie and Weiwei Qian and Jiale Tong and Peng Deng and Haoyu Wang},
journal = {BMC Neurology},
year = {2026},
month = aug,
doi = {10.1186/s12883-026-05242-4},
url = {https://doi.org/10.1186/s12883-026-05242-4},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinical study on the combined predictive value of admission neutrophil-to-lymphocyte ratio and stress hyperglycemia ratio for early neurological deterioration in acute ischemic stroke
AU - Juan Xie
AU - Weiwei Qian
AU - Jiale Tong
AU - Peng Deng
AU - Haoyu Wang
PY - 2026
DA - 2026/08/10
JO - BMC Neurology
DO - 10.1186/s12883-026-05242-4
UR - https://doi.org/10.1186/s12883-026-05242-4
AB - Background: Early neurological deterioration (END) affects short-term prognosis in acute ischemic stroke. Inflammation and stress-related glucose dysregulation may contribute to END, but their incremental predictive value remains unclear. Objective: To evaluate the associations of admission neutrophil-to-lymphocyte ratio (NLR) and stress hyperglycemia ratio (SHR) with END and assess whether adding these biomarkers to clinical variables improves risk discrimination. Methods: This single-center retrospective cohort study included 180 patients with acute ischemic stroke admitted between January 2021 and December 2024. NLR was calculated as neutrophil/lymphocyte ratio. SHR was calculated as admission glucose/estimated average glucose and rescaled as SHR_0.1 = SHR/0.1 before regression, so that the OR represented each 0.1-unit increase. END was defined as an NIHSS increase ≥ 2 within 72 h. Multivariate logistic regression and ROC analysis were performed. Results: END occurred in 38 patients (21.1%). NLR was independently associated with END per 1-unit increase (OR = 1.193, 95% CI 1.071–1.328, P = 0.001). Rescaled SHR was independently associated with END per 0.1-unit increase (OR = 1.241, 95% CI 1.082–1.424, P = 0.002). The basic clinical model had an AUC of 0.793, whereas adding NLR and SHR increased the AUC to 0.884. Conclusion: Admission NLR and rescaled SHR were independently associated with END. Adding these routine biomarkers to clinical variables may improve early END risk stratification, pending external validation. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12883-026-05242-4.
SN - 1471-2377
ER -