Admission lymphocyte-to-monocyte and platelet-to-lymphocyte ratios and outcomes in young patients with ischemic stroke

Background To examine the associations of admission lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) for short- and long-term functional outcomes, imaging endpoints, and neurological severity in young patients with ischemic stroke. Methods This single-center retrospective study included young patients aged 18–45 years with ischemic stroke admitted to Beijing Tiantan Hospital between January 2019 and December 2021. The primary outcome was functional dependence or death (modified Rankin Scale [mRS] score 2–6) at discharge and 3 months. Secondary outcomes were early neurological deterioration (END), hemorrhagic transformation (HT), cerebral microbleeds (CMB) detected during hospitalization, and serial National Institutes of Health Stroke Scale (NIHSS) scores. Proportional-odds logistic regression, binary logistic regression, linear mixed-effects models, and restricted cubic splines were used. Results Among 637 patients, higher LMR was associated with poor functional outcome at 3 months (adjusted OR = 0.928; 95% CI 0.860–0.989; p = 0.045) and lower odds of CMB (adjusted OR = 0.819; 95% CI 0.704–0.951; p = 0.009). Neither LMR nor PLR was associated with discharge mRS, HT, or END after full adjustment. Adding LMR or PLR to the covariate-only models resulted in minimal numerical improvement in discrimination; for 3-month functional dependence or death, the AUC increased from 0.635 to 0.643 and 0.646, respectively. Restricted cubic spline analyses identified a nominal nonlinear associations only between PLR and HT (P for nonlinearity = 0.035); all other nonlinear components were nonsignificant, and confidence intervals widened at the exposure tails. Conclusion Admission LMR was associated with 3-month functional outcome and CMB. And PLR was not independently associated with functional or imaging outcomes after full adjustment.