Research Article| Volume 324, ISSUE 1-2, P49-52, January 15, 2013

Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation

Published:October 18, 2012DOI:



      Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of NLR in patients with thromboembolic stroke due to atrial fibrillation (AF). We aimed to compare the NLR ratios between non-valvular AF patients with or without thromboembolic stroke.


      A total of 126 non-valvular AF patients with or without stroke were included in the study; 126 consecutive patients (52 males and 74 females), mean age, 70±10.2 years old. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. WBC count>12.000 cells per μL or <4.000 cells per μL and high body temperature>38 º are excluded from the study.


      Mean NLR was significantly higher among persons with stroke compared to individuals without a stroke (5.6±3.4 vs. 3.1±2.1, p=0.001). There were no significant differences in RDW levels between the two groups (p>0.05). HAS-BLED and CHADS2 scores were significantly higher in the stroke group.


      Higher NLR, an emerging marker of inflammation, is associated with thromboembolic stroke in non-valvular AF patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pieri A.
        • Lopes T.O.
        • Gabbai A.A.
        Stratification with CHA2DS2-VASc score is better than CHADS2 score in reducing ischemic stroke risk in patients with atrial fibrillation.
        Int J Stroke. 2011; 6: 466
        • Mason P.K.
        • Lake D.E.
        • DiMarco J.P.
        • Ferguson J.D.
        • Mangrum J.M.
        • Bilchick K.
        • et al.
        Impact of the CHA2DS2-VASc score on anticoagulation recommendations for atrial fibrillation.
        Am J Med. 2012; 125: 603
        • Ha S.I.
        • Choi D.H.
        • Ki Y.J.
        • Yang J.S.
        • Park G.
        • Chung J.W.
        • et al.
        Stroke prediction using mean platelet volume in patients with atrial fibrillation.
        Platelets. 2011; 22: 408-414
        • Hijazi Z.
        • Oldgren J.
        • Andersson U.
        • Connolly S.J.
        • Ezekowitz M.D.
        • Hohnloser S.H.
        • et al.
        Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) substudy.
        Circulation. 2012; 125: 1605-1616
        • Licata G.
        • Tuttolomondo A.
        • Di Raimondo D.
        • Corrao S.
        • Di Sciacca R.
        • Pinto A.
        Immuno-inflammatory activation in acute cardio-embolic strokes in comparison with other subtypes of ischaemic stroke.
        Thromb Haemost. 2009; 101: 929-937
        • Rietbrock S.
        • Heeley E.
        • Plumb J.
        • van Staa T.
        Chronic atrial fibrillation: incidence, prevalence, and prediction of stroke using the Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack (CHADS2) risk stratification scheme.
        Am Heart J. 2008; 156: 57-64
        • Pisters R.
        • Lane D.A.
        • Nieuwlaat R.
        • de Vos C.B.
        • Crijns H.J.
        • Lip G.Y.
        A novel user-friendly score (HAS-BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.
        Chest. 2010; 138: 1093-1100
        • Schiller N.B.
        • Shah P.M.
        • Crawford M.
        • DeMaria A.
        • Devereux R.
        • Feigenbaum H.
        • et al.
        Recommendations for quantitation of the left ventricle by two-dimensional echocardiography.
        J Am Soc Echocardiogr. 1989; 2: 358-367
        • Horne B.D.
        • Anderson J.L.
        • John J.M.
        • Weaver A.
        • Bair T.L.
        • Jensen K.R.
        • et al.
        Intermountain Heart Collaborative Study Group. Which white blood cell subtypes predict increased cardiovascular risk?.
        J Am Coll Cardiol. 2005; 45: 1638-1643
        • Zahorec R.
        Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill.
        Bratisl Lek Listy. 2001; 1: 5-14
        • Onsrud M.
        • Thorsby E.
        Influence of in vivo hydrocortisone on some human blood lymphocyte subpopulations. Effect on natural killer cell activity.
        Scand J Immunol. 1981; 13: 573-579
        • Hotchkiss R.S.
        • Karl I.E.
        The pathophysiology and treatment of sepsis.
        N Engl J Med. 2003; 348: 138-150
        • Pellizzon G.G.
        • Dixon S.R.
        • Gregg W.
        • Cox D.A.
        • Mattos L.
        • Boura J.A.
        • et al.
        Stent PAMI Investigators. Relation of admission white blood cell count to long-term outcomes after primary coronary angioplasty for acute myocardial infarction.
        Am J Cardiol. 2003; 91: 729-731
        • Núñez J.
        • Núñez E.
        • Bodí V.
        • Sanchis J.
        • Miñana G.
        • Mainar L.
        • et al.
        Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction.
        Am J Cardiol. 2008; 101: 747-752
        • Uthamalingam S.
        • Patvardhan E.A.
        • Subramanian S.
        • Ahmed W.
        • Martin W.
        • Daley M.
        • et al.
        Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure.
        Am J Cardiol. 2011; 107: 433-438
        • Aviles R.J.
        • Martin D.O.
        • Apperson-Hansen C.
        • Houghtaling P.L.
        • Rautaharju P.
        • Kronmal R.A.
        • et al.
        Inflammation as a risk factor for atrial fibrillation.
        Circulation. 2003; 108: 3006-3010
        • Aronson D.
        • Boulos M.
        • Suleiman A.
        • Bidoosi S.
        • Agmon Y.
        • Kapeliovich M.
        • et al.
        Relation of C-reactive protein and new-onset atrial fibrillation in patients with acute myocardial infarction.
        Am J Cardiol. 2007; 100: 753-757
        • Chung M.K.
        • Martin D.O.
        • Sprecher D.
        • Wazni O.
        • Kanderian A.
        • Carnes C.A.
        • et al.
        C-reactive protein elevation in patients with atrial arrhythmias. Inflammatory mechanisms and persistence of atrial fibrillation.
        Circulation. 2001; 104: 2886-2891
        • Marin F.
        • Corral J.
        • Roldan V.
        • Gonzalez-Conejero R.
        • del Rey M.L.
        • Sogorb F.
        • et al.
        Factor XIII Val34Leu polymorphism modulates the prothrombotic and inflammatory state associated with atrial fibrillation.
        J Mol Cell Cardiol. 2004; 37: 699-704
        • Lip G.Y.H.
        • Patel J.V.
        • Hughes E.
        • Hart R.G.
        High-sensitivity C-reactive protein and soluble CD40 ligand as indices of inflammation and platelet activation in 880 patients with nonvalvular atrial fibrillation relationship to stroke risk factors, stroke risk stratification schema, and prognosis.
        Stroke. 2007; 38: 1229-1237
        • Pinto A.
        • Tuttolomondo A.
        • Casuccio A.
        • Di Raimondo D.
        • Di Sciacca R.
        • Arnao V.
        • et al.
        Immuno-inflammatory predictors of stroke at follow-up in patients with chronic non-valvular atrial fibrillation (NVAF).
        Clin Sci (Lond). 2009; 116: 781-789