Introduction Systemic inflammation contributes to secondary injury after acute stroke. The neutrophil‐to‐lymphocyte ratio (NLR) is an accessible biomarker with potential prognostic value, yet its performance in Latin American tertiary settings remains under‐characterized. We aimed to determine the prognostic and predictive value of admission NLR for 30‐day functional outcomes (modified Rankin Scale) in patients with ischemic and hemorrhagic stroke treated at a tertiary referral hospital. Methods Prospective cohort at Hospital Nacional Mario Catarino Rivas , a tertiary referral hospital in San Pedro Sula, Honduras. We consecutively enrolled 384 adults (≥18 years) with acute ischemic or intracerebral hemorrhagic stroke admitted between October 2023 and August 2024 ; diagnoses were confirmed by a neurologist and CT/MRI . The neutrophil‐to‐lymphocyte ratio (NLR = absolute neutrophils/absolute lymphocytes) was calculated from the first admission CBC obtained ≤24 h after arrival (sensitivity analysis ≤72 h). The primary outcome was 30‐day poor functional status (mRS ≥3) ascertained in clinic or by telephone. Discrimination was assessed with ROC/AUC, and an exploratory cut‐point was selected using Youden's J. Logistic regression (unadjusted and multivariable) estimated odds ratios (OR, 95% CI) , adjusting for age, baseline NIHSS, stroke subtype, admission glucose/diabetes, blood pressure, and atrial fibrillation. Results Admission NLR predicted 30‐day outcome overall (AUC 0.726; 95%CI 0.647‐0.806; p<0.001), with better discrimination in hemorrhagic stroke (AUC 0.788; p=0.003) than in ischemic stroke (AUC 0.621; p=0.064). At the commonly cited threshold (NLR≈5), sensitivity was moderate and specificity limited , particularly in ischemic stroke; subtype‐specific Youden thresholds improved the balance of sensitivity and specificity. Conclusions In a tertiary setting, admission neutrophil‐to‐lymphocyte ratio (NLR) showed acceptable discrimination for 30‐day functional outcomes, with stronger performance in intracerebral hemorrhage than ischemic stroke. Given moderate sensitivity and limited specificity at common cutoffs, NLR should complement not replace clinical predictors ; standardized early sampling windows, adjustment for key confounders, and subtype‐specific thresholds are essential for risk stratification in diverse healthcare environments and warrant external validation. image
Iván García Tercero (Sat,) studied this question.