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

Abstract

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. 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. 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. 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. 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.