NLR and Hcy levels at admission are independently associated with more severe neurological deficits in AIS patients and may facilitate early risk stratification.
Key Findings
Results
The moderate-to-severe stroke group had significantly higher NLR and Hcy levels compared to the mild stroke group.
Patients were divided into mild stroke (NIHSS ≤ 5, n = 80) and moderate-to-severe stroke (NIHSS > 5, n = 58) groups.
NLR and Hcy were among the key laboratory indicators compared between the two groups.
These differences were identified through comparison of demographic characteristics, medical history, and laboratory indicators between groups.
The study was retrospective, conducted on 138 newly diagnosed AIS patients admitted from January 2022 to October 2025.
Results
The moderate-to-severe stroke group had a higher proportion of atrial fibrillation and pre-stroke disability compared to the mild stroke group.
Atrial fibrillation prevalence was greater in the moderate-to-severe stroke group (NIHSS > 5, n = 58) than the mild group (NIHSS ≤ 5, n = 80).
Pre-stroke disability was more prevalent in the moderate-to-severe stroke group.
These differences were identified through univariate comparison between the two groups.
The study population consisted of 138 newly diagnosed AIS patients at Handan First Hospital.
Results
NLR was independently associated with higher odds of moderate-to-severe acute ischemic stroke on multivariate logistic regression.
Multivariate logistic regression analysis was used to identify independent factors associated with stroke severity.
NLR was identified as one of four independent risk factors for moderate-to-severe AIS.
The analysis controlled for other variables including Hcy, pre-stroke disability, and responsible large vessel stenosis.
NLR is described as a 'readily accessible biomarker' available at admission.
Results
Homocysteine (Hcy) was independently associated with higher odds of moderate-to-severe acute ischemic stroke on multivariate logistic regression.
Multivariate logistic regression analysis identified Hcy as an independent factor associated with stroke severity.
Hcy was one of four independent risk factors for moderate-to-severe AIS.
The analysis controlled for other variables including NLR, pre-stroke disability, and responsible large vessel stenosis.
Hcy is described as a 'readily accessible biomarker' measurable at admission.
Results
Pre-stroke disability and responsible large vessel stenosis were independently associated with higher odds of moderate-to-severe AIS.
Both pre-stroke disability and responsible large vessel stenosis were identified as independent risk factors in multivariate logistic regression.
The status of responsible large vessel stenosis was among the variables compared between the mild and moderate-to-severe groups.
These factors were identified alongside NLR and Hcy as independent predictors of stroke severity.
The analysis was conducted on 138 AIS patients using multivariate logistic regression.
Results
A history of transient ischemic attack (TIA) was identified as an independent protective factor against moderate-to-severe AIS.
TIA history was associated with lower odds of moderate-to-severe stroke on multivariate logistic regression.
This finding suggests a possible preconditioning or protective effect of prior TIA.
TIA history was identified as the sole independent protective factor in the multivariate model.
This association was detected in a retrospective cohort of 138 AIS patients.
Methods
The study population consisted of 138 newly diagnosed AIS patients retrospectively analyzed from a single center.
Patients were admitted to Handan First Hospital from January 2022 to October 2025.
80 patients were classified as mild stroke (NIHSS ≤ 5) and 58 as moderate-to-severe stroke (NIHSS > 5).
The study design was retrospective.
Stroke severity was classified using the National Institutes of Health Stroke Scale (NIHSS).
What This Means
This research examined whether two commonly measured blood markers — the neutrophil-to-lymphocyte ratio (NLR, a measure of immune system activation) and homocysteine (Hcy, an amino acid linked to cardiovascular risk) — are related to how severe a stroke is when a patient arrives at the hospital. Researchers reviewed records from 138 stroke patients and found that those with more severe strokes (based on a standard neurological scoring system) had higher levels of both NLR and Hcy compared to those with milder strokes. After accounting for other factors, both markers remained independently linked to greater stroke severity.
The study also found that having atrial fibrillation (an irregular heart rhythm), pre-existing disability before the stroke, and significant narrowing of a major brain artery were all associated with more severe strokes. Interestingly, patients with a prior history of transient ischemic attack (a 'mini-stroke') appeared to be somewhat protected against more severe strokes, which may suggest that a previous TIA triggers some protective adaptation in the brain.
This research suggests that NLR and Hcy — both of which can be measured with routine blood tests already taken when patients arrive at the hospital — could help doctors quickly identify which stroke patients are at higher risk for more severe neurological damage. If confirmed in larger studies, these findings could support using these simple, inexpensive blood markers as part of early stroke assessment and triage.
Du Y, Yang F, Liu Y. (2026). Correlation of composite inflammatory indices and homocysteine with the severity of acute ischemic stroke: A retrospective study.. Medicine. https://doi.org/10.1097/MD.0000000000049176