Objective: The purpose of this study is to investigate the prognostic value of peripheral blood leukocyte count, neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in patients with acute non-cardiogenic ischemic stroke.

Methods: From June 1, 2017 to June 1, 2018, 323 patients with acute non-cardiogenic ischemic stroke who were hospitalized in the Department of Neurology, Affiliated Hospital of Chengde Medical College, met the criteria of case selection. The data of demography, vascular risk factors, drug use history, blood routine test, National Institutes of Health Stroke Scale (NIHSS) score at admission, modified Rankin Scale (MRS) score at discharge and duration of hospitalization were collected for retrospective analysis. According to the peripheral blood leukocyte count, the groups were divided as follows: ≤10.0×10⁹/L, (10.1-11.0)×10⁹/L,(11.1-12.0)×10⁹/L and ≥12.1×10⁹/L; according to NLR, the groups were divided as follows: <3.6, 3.6-6.5 and >6.5; according to LMR, the groups were divided as follows: <2.97, 2.97-4.83 and >4.83. Multivariate logistic regression was used to analyze the independent risk factors of prognosis in patients with acute non-cardiogenic ischemic stroke. The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of peripheral blood leukocyte count, NLR and LMR on prognosis, and calculate the sensitivity and specificity.

Results: According to MRS score, the patients were divided into two groups: good prognosis group (213 cases, MRS score ≤ 2) and poor prognosis group (110 cases, MRS score is 3-6). The neutrophil count, NLR, hypersensitive C-reactive protein, homocysteine and baseline NHISS score in the poor prognosis group were significantly higher than those in the good prognosis group (P<0.05), and the duration of hospitalization was significantly longer (P<0.05), while the lymphocyte count and LMR in the poor prognosis group were significantly lower than those in the good prognosis group (P<0.05). The results of multivariate logistic regression analysis showed that the peripheral blood leukocyte count [≤10.0×10⁹·L^－1 vs (10.1-11.0)×10⁹·L^－1: odds ratio: 1.788 (95% confidence interval: 1.119-2.854), P=0.015], NLR [odds ratio: 1.275 (95% confidence interval: 1.031-1.576), P=0.025], LMR [<2.97 vs 2.97-4.83: odds ratio: 0.277 (95% confidence interval: 0.072-0.814), P=0.013], the level of hypersensitive C-reactive protein [odds ratio: 2.389 (95% confidence interval: 1.194-4.799), P=0.014], and the baseline NHISS score [odds ratio: 12.630 (95% confidence interval: 6.115-27.741), P<0.001] were independent risk factors for prognosis of patients with acute non-cardiogenic ischemic stroke. The results of ROC curve showed that leukocyte count, NLR and LMR were not ideal predictors for the prognosis of acute non-cardiogenic ischemic stroke, and the combined detection might have a higher predictive value.

Conclusion: Peripheral blood leukocyte count, NLR, LMR, high-sensitivity C-reactive protein level and baseline NIHSS score were independent risk factors of prognosis (MRS score) in patients with acute non-cardiogenic ischemic stroke. Due to the convenience and low cost of peripheral blood leukocyte count, NLR and LMR detection, it is suitable for clinical application. It is necessary to carry out multi-center prospective studies with a larger sample to further verify.