İnmede İnflamatuar ve Metabolik Belirteçler: NLR ve GPR'nin Tanısal ve Prognostik İlişkileri

Öz

Nötrofil-lenfosit oranı (NLR) ve glukoz-potasyum oranı (GPR), akut inmede inflamatuvar ve metabolik yanıtları yansıtan, basit ve kolay erişilebilir belirteçlerdir. Ancak, acil servis (AS) başvurularındaki tanısal değerleri belirsizliğini korumaktadır. Bu çalışma, inme benzeri semptomlarla başvuran hastalarda NLR ve GPR’nin inme ile ilişkisini değerlendirmeyi amaçlamıştır. Bu retrospektif çalışmaya toplam 475 katılımcı (286 inme, 189 kontrol) dahil edilmiştir. Demografik, klinik ve laboratuvar verileri analiz edilmiştir. Bağımsız belirleyiciler çok değişkenli lojistik regresyon analizi ile belirlenmiş, tanısal performans ise alıcı işletim karakteristiği (ROC) analizi ile değerlendirilmiştir. İnme hastaları kontrol grubuna kıyasla daha yaşlıydı (59 vs. 43 yıl, p<0.001) ve hipertansiyon, diyabetes mellitus ve koroner arter hastalığı prevalansları daha yüksekti (tümü p<0.05). NLR, GPR ve C-reaktif protein düzeyleri daha yüksek bulunurken (tümü p<0.001), lenfosit sayıları (p=0.015) ve albümin düzeyleri (p=0.018) daha düşüktü. Yaş, hem iskemik hem de hemorajik inme için bağımsız bir belirleyici olarak saptandı (p<0.001). GPR, iskemik inme ile bağımsız olarak ilişkiliydi (OR=1.08, %95 GA: 1.05–1.12, p<0.001). Hemorajik inmede ise hem NLR (OR=1.40, %95 GA: 1.20–1.65, p<0.001) hem de GPR (OR=1.13, %95 GA: 1.06–1.21, p<0.001) anlamlılığını korudu. Hipertansiyon, hemorajik inme ile en güçlü ilişkiyi gösterdi (p<0.001). ROC analizi, orta düzeyde ayırt edici performans gösterdi (AUC: NLR için 0.636; GPR için 0.729). NLR ve GPR inme hastalarında yüksek bulunmuş ve orta düzeyde tanısal performans göstermiştir. GPR iskemik inme ile ilişkiliyken, her iki belirteç de hemorajik inme ile ilişkili bulunmuş olup, tamamlayıcı patofizyolojik rollere işaret etmektedir.

Anahtar Kelimeler

• Serebrovasküler olay
• glikoz-potasyum oranı
• inflamasyon
• metabolik düzensizlik
• nötrofil-lenfosit oranı.

Inflammatory and Metabolic Markers in Stroke: Diagnostic and Prognostic Associations of NLR and GPR

Öz

The neutrophil-to-lymphocyte ratio (NLR) and glucose-to-potassium ratio (GPR) are simple, readily available markers reflecting inflammatory and metabolic responses in acute stroke. However, their diagnostic value in emergency department (ED) presentations remains uncertain. This study evaluated the association of NLR and GPR with stroke among patients presenting with stroke-like symptoms. This retrospective study included 475 participants (286 stroke, 189 controls). Demographic, clinical, and laboratory data were analyzed. Independent predictors were identified using multivariable logistic regression, and diagnostic performance was assessed with receiver operating characteristic (ROC) analysis. Stroke patients were older than controls (59 vs. 43 years, p<0.001) and had higher prevalences of hypertension, diabetes mellitus, and coronary artery disease (all p<0.05). NLR, GPR, and C-reactive protein levels were higher (all p<0.001), while lymphocyte counts (p=0.015) and albumin levels (p=0.018) were lower. Age was an independent predictor of both ischemic and hemorrhagic stroke (p<0.001). GPR was independently associated with ischemic stroke (OR=1.08, 95% CI: 1.05–1.12, p<0.001). In hemorrhagic stroke, both NLR (OR=1.40, 95% CI: 1.20–1.65, p<0.001) and GPR (OR=1.13, 95% CI: 1.06–1.21, p<0.001) remained significant. Hypertension showed the strongest association with hemorrhagic stroke (p<0.001). ROC analysis demonstrated moderate discrimination (AUC: 0.636 for NLR; 0.729 for GPR). NLR and GPR were elevated in stroke and showed moderate diagnostic performance. GPR was associated with ischemic stroke, whereas both markers were linked to hemorrhagic stroke, suggesting complementary pathophysiological roles.

Anahtar Kelimeler

• Cerebrovascular accident
• glucose-to-potassium ratio
• inflammation
• metabolic dysregulation
• neutrophil-to-lymphocyte ratio.

Kaynakça

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