Correlation of composite inflammatory indices and homocysteine with the severity of acute ischemic stroke: A retrospective study

This study aimed to analyze the correlation between the neutrophil-to-lymphocyte ratio (NLR), homocysteine (Hcy), and the severity of acute ischemic stroke (AIS) to provide evidence-based support for early risk stratification. A retrospective analysis was conducted on 138 newly diagnosed AIS patients admitted to Handan First Hospital from January 2022 to October 2025. According to the National Institutes of Health Stroke Scale (NIHSS), patients were divided into a mild stroke group (NIHSS ≤ 5, n = 80) and a moderate-to-severe stroke group (NIHSS > 5, n = 58). Demographic characteristics, medical history, laboratory indicators (including NLR and Hcy), and the status of responsible large vessel stenosis were compared between the 2 groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with stroke severity. Compared with the mild stroke group, the moderate-to-severe stroke group had a higher proportion of atrial fibrillation, a higher proportion of pre-stroke disability, and higher levels of NLR and Hcy. Multivariate logistic regression analysis revealed that NLR, Hcy, pre-stroke disability, and responsible large vessel stenosis were independently associated with higher odds of moderate-to-severe AIS, while a history of transient ischemic attack was identified as an independent protective factor. NLR and Hcy levels at admission are independently associated with more severe neurological deficits in AIS patients. These readily accessible biomarkers may facilitate early risk stratification and inform clinical decision-making.