Background Delirium is an underdiagnosed and possibly preventable complication in acute stroke and is linked to poor outcome. Neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, is also associated with poor outcome after acute ischemic stroke. Aim To determine whether NLR is a predictor of post-stroke delirium (PSD). Methods We reviewed the UZ Brussel stroke database and included 514 patients with acute ischemic stroke within 24 hours from stroke onset between February 2009 and December 2014. The presence of delirium was evaluated by two raters based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, using a retrospective chart review method. When no consensus was reached, a third evaluator was consulted. Patients were divided into two groups: those who developed delirium within the first week after stroke onset (n = 201; 39%) and those who did not (n = 313; 61%). Receiver operating characteristics (ROC) and multiple logistic regression analysis (MLRA) were used to identify predictors of PSD. Results MLRA showed that NLR (odds ratio (OR) 1.14; 95% confidence interval (CI) 1.04–1.26), age (OR 1.05; 95% CI 1.03–1.07), National Institutes of Health Stroke Scale (NIHSS; OR 1.14; 95% CI 1.10–1.18), premorbid modified Rankin Scale (mRS) (OR 1.35; 95% CI 1.05–1.74) and premorbid cognitive dysfunction (OR 3.16; 95% CI 1.26–7.92) predicted PSD. ROC curve of a prediction model including NLR, age, NIHSS and premorbid cognitive dysfunction showed an area under the curve of 0.84 (95% CI = 0.81–0.88). Conclusions Besides age, stroke severity, premorbid mRS and cognitive impairment, NLR is a predictor of PSD, even independent of the development of pneumonia or urinary tract infection.

中文翻译：

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中性粒细胞与淋巴细胞的比率可预测中风后的谵妄

背景 谵妄是急性卒中中一种诊断不足且可能可预防的并发症，与预后不良有关。中性粒细胞与淋巴细胞的比率 (NLR) 是全身炎症的标志物，也与急性缺血性卒中后的不良预后相关。目的 确定 NLR 是否是卒中后谵妄 (PSD) 的预测因子。方法 我们回顾了 UZ 布鲁塞尔卒中数据库，纳入了 2009 年 2 月至 2014 年 12 月卒中发作后 24 小时内的 514 名急性缺血性卒中患者。由两名评估者根据《精神疾病诊断和统计手册》第五版评估谵妄的存在。版本标准，采用回顾性图表审查方法。如果没有达成共识，则咨询了第三位评估员。患者分为两组：中风发作后第一周内出现谵妄的患者（n = 201；39%）和未出现谵妄的患者（n = 313；61%）。接受者操作特征 (ROC) 和多元逻辑回归分析 (MLRA) 用于确定 PSD 的预测因子。结果 MLRA 显示 NLR（优势比 (OR) 1.14；95% 置信区间 (CI) 1.04–1.26）、年龄（OR 1.05；95% CI 1.03–1.07）、美国国立卫生研究院卒中量表（NIHSS；OR 1.14； 95% CI 1.10–1.18)、病前改良 Rankin 量表 (mRS) (OR 1.35；95% CI 1.05–1.74) 和病前认知功能障碍 (OR 3.16；95% CI 1.26–7.92) 可预测 PSD。包括 NLR、年龄、NIHSS 和发病前认知功能障碍的预测模型的 ROC 曲线显示曲线下面积为 0.84（95% CI = 0.81-0.88）。结论 除了年龄、卒中严重程度、病前 mRS 和认知障碍外，