Role of Lymphocyte-Monocyte Ratio in predicting the prognosis and outcome of patients with Acute Ischemic Stroke
International Clinical Neuroscience Journal,
Vol. 11 No. 1 (2024),
4 November 2025
,
Page e8
https://doi.org/10.22037/icnj.v11i1.47966
Abstract
Background: Acute ischemic stroke is a sudden disruption in blood flow to the brain, leading to neuronal damage that occurs secondary to inflammation. The outcome depends on the type of stroke, the duration of treatment, and the patient's physical status. Lymphocyte-to-monocyte ratio (LMR) is an emerging biomarker that can predict stroke severity and functional outcome in AIS patients.
Methods: This was a prospective, observational study including cases of ischemic stroke presenting to a tertiary care center in Kerala. Patients with neurological symptoms were evaluated according to the NIHSS score, and blood samples were sent for analysis. Patients who presented to the emergency department from July 2024 to December 2024 were included in the study, and a total of 126 patients were observed
Results: This study shows that the NIHSS score used to grade stroke severity at admission was negatively associated with LMR values. This shows that lower LMR values are associated with greater stroke severity. A cutoff value of 2.9 was used for this study, and it showed high accuracy. The result of the Spearman correlation showed that there was a very high, negative correlation between LMR and NIHSS Score. The results showed that this correlation between LMR and NIHSS Score was a statistically significant negative correlation, r(124) = -0.71, p = <.001.
Conclusion: LMR can be used as an important and effective biomarker in evaluating the severity of the disease and in predicting the outcome in patients with acute ischemic stroke.
- Acute ischemic stroke
- Lymphocyte Monocyte ratio
- NIHSS
How to Cite
References
1. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harrison’s Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Education; 2018. p. 3068.
2. Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res. 2017;120(3):472–495. doi: 10.1161/CIRCRESAHA.116.308398
3. Kalkonde YV, Deshmukh MD, Sahane V, Puthran J, Kakarmath S, Agavane V, et al. Stroke is the leading cause of death in rural Gadchiroli, India: A prospective community-based study. Stroke. 2015;46(7):1764–1768. doi: 10.1161/STROKEAHA.115.008067
4. Ram CVS, Kumar S, Renjen PN, Kumar GP, Swaminathan J, Reddy CR, et al. Risk factors predisposing to acute stroke in India: A prospective study. J Hypertens. 2021;39(11):2183–2189. doi: 10.1097/HJH.0000000000002915
5. Ji H, Li Y, Fan Z, et al. Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment. BMC Cardiovasc Disord. 2017;17:90. doi: 10.1186/s12872-017-0512-6
6. Zhu JY, Liu CC, Wang L, et al. Peripheral blood lymphocyte-to-monocyte ratio as a prognostic factor in advanced epithelial ovarian cancer: a multicenter retrospective study. J Cancer. 2017;8(5):737–743. doi: 10.7150/jca.17199
7. Ren H, Liu X, Wang L, et al. Lymphocyte-to-monocyte ratio: a novel predictor of the prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis. 2017;26(11):2595–2602. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.019
8. ElAli A, Jean LeBlanc N. The role of monocytes in ischemic stroke pathobiology: new avenues to explore. Front Aging Neurosci. 2016;8:29. doi: 10.3389/fnagi.2016.00029
9. Liesz A, Suri-Payer E, Veltkamp C, et al. Regulatory T cells are key cerebroprotective immunomodulators in acute experimental stroke. Nat Med. 2009;15(2):192–199. doi: 10.1038/nm.1927
10. Li P, Mao L, Zhou G, et al. Adoptive regulatory T-cell therapy preserves systemic immune homeostasis after cerebral ischemia. Stroke. 2013;44(12):3509–3515. doi: 10.1161/STROKEAHA.113.002637
11. Prabhu S, Harshavardhan L. Role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio in acute ischaemic stroke severity: a prospective cohort study. J Clin Diagn Res. 2023;17(10):OC12–OC16. doi: 10.7860/JCDR/2023/64152/18614
12. Bonifacic D, Toplak A, Benjak I, et al. Monocytes and monocyte chemoattractant protein-1 (MCP-1) as early predictors of disease outcome in patients with cerebral ischemic stroke. Wien Klin Wochenschr. 2016;128(Suppl 7):20–27. doi: 10.1007/s00508-015-0864-1
13. Zhang Y, Xing Z, Zhou K, et al. The predictive role of systemic inflammation response index (SIRI) in the prognosis of stroke patients. Clin Interv Aging. 2021;16:1997–2007. doi: 10.2147/CIA.S339221
14. 1Park MG, Kim MK, Chae SH, et al. Lymphocyte-to-monocyte ratio on day 7 is associated with outcomes in acute ischemic stroke. Neurol Sci. 2018;39(2):243–249. doi: 10.1007/s10072-017-3163-7
15. Mao X, Yu Q, Liao Y, et al. Lymphocyte-to-monocyte ratio is independently associated with progressive infarction in patients with acute ischemic stroke. Biomed Res Int. 2022;2022:2290524. doi: 10.1155/2022/2290524
16. Lux D, Alakbarzade V, Bridge L, et al. The association of neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio with 3-month clinical outcome after mechanical thrombectomy following stroke. J Neuroinflammation. 2020;17:60. doi: 10.1186/s12974-020-01739-y
17. Grimm RH Jr, Neaton JD, Ludwig W. Prognostic importance of the white blood cell count for coronary, cancer, and all-cause mortality. JAMA. 1985;254(14):1932–1937. doi: 10.1001/jama.254.14.1932
18. Shankar A, Wang JJ, Rochtchina E, et al. Association between circulating white blood cell count and cancer mortality: a population-based cohort study. Arch Intern Med. 2006;166(2):188–194. doi: 10.1001/archinte.166.2.188
19. Margolis KL, Manson JE, Greenland P, et al. Leukocyte count as a predictor of cardiovascular events and mortality in postmenopausal women: The Women's Health Initiative Observational Study. Arch Intern Med. 2005;165(5):500–508. doi: 10.1001/archinte.165.5.500
20. Kabat GC, Kim MY, Manson JE, et al. White blood cell count and total and cause-specific mortality in the Women's Health Initiative. Am J Epidemiol. 2017;186(1):63–72. doi: 10.1093/aje/kww226
21. Cai M, Liang D, Gao F, Hong X, Feng X, Yang Y, et al. Association of lymphocyte-to-monocyte ratio with the long-term outcome after hospital discharge in patients with ST-elevation myocardial infarction: a retrospective cohort study. Coron Artery Dis. 2020;31(3):248–254. doi: 10.1097/MCA.0000000000000837
22. Song W, Tian C, Wang K, et al. The pretreatment lymphocyte-to-monocyte ratio predicts clinical outcome for patients with hepatocellular carcinoma: a meta-analysis. Sci Rep. 2017;7:46601. doi: 10.1038/srep46601
23. Sadeghi F, Sarkady F, Zsóri KS, et al. High neutrophil-lymphocyte ratio and low lymphocyte-monocyte ratio combination after thrombolysis is a potential predictor of poor functional outcome of acute ischemic stroke. J Pers Med. 2022;12(8):1221. doi: 10.3390/jpm12081221
24. Song Q, Pan R, Jin Y, et al. Lymphocyte-to-monocyte ratio and risk of hemorrhagic transformation in patients with acute ischemic stroke. Neurol Sci. 2020;41(9):2511–2520. doi: 10.1007/s10072-020-04355-z
25. Li G, Hao Y, Wang C, et al. Association between neutrophil-to-lymphocyte ratio/lymphocyte-to-monocyte ratio and in-hospital clinical outcomes in ischemic stroke treated with intravenous thrombolysis. J Inflamm Res. 2022;15:5567–5578. doi: 10.2147/JIR.S382876
26. Chen C, Gu L, Chen L, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as potential predictors of prognosis in acute ischemic stroke. Front Neurol. 2020;11:525621. doi: 10.3389/fneur.2020.525621
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