Lymphocyte-to-monocyte ratio as a prognostic marker for stroke severity and functional outcome: A prospective observational study

Inflammatory markers and dysregulation of certain cell subtypes play a crucial role in stroke severity and complications. This study aimed to determine the correlation of the lymphocyte-monocyte ratio (LMR) with stroke severity and outcome and establish its potential as a prognostic marker in stroke patients in the Indian population. In this prospective observational study, 102 patients with ischemic and hemorrhagic strokes were included. LMR was calculated from the initial complete blood count analysis at admission. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score, and the 30-day functional outcome was classified according to the modified Rankin Scale (mRS). The correlation between LMR and NIHSS and mRS was determined using Pearson's correlation test, and the predictive value of LMR was established using ROC Most patients (75.5%) had ischemic stroke, and the relative risk of mortality in hemorrhagic stroke was 2.64, higher than in ischemic stroke. ROC curve analysis showed that a lower LMR value was an independent predictor of poor outcome (mRS > 3) in stroke patients at 30 days, with an area under the curve (AUC) of 0.844 (95% CI 0.766-0.922, P<0.001). An LMR cut-off of 2.34 was found to be 86.5% sensitive and 74% specific in predicting poor outcomes. The lymphocyte-monocyte ratio at admission was strongly associated with stroke severity and functional outcome, with a significant moderate negative correlation and can be used a prognostic marker.