To the Editor, We read with great interest the recent article by Nam et al [1], focused on the association between the neutrophil-to-lymphocyte ratio (NLR) and the stroke-associated pneumonia (SAP) in patients with acute ischemic stroke. NLR correlates with both pneumonia and stroke severity indexes in patients with acute ischemic stroke vulnerable to pneumonia. Although the design as 2-center retrospective study would limit the generalization of the results, the Authors [1] intriguingly emphasized the potential role of NLR as a marker of higher risk for developing SAP. This further strengthens the role of admission NLR as short- and long-term outcome predictor in acute ischemic stroke, especially large vessel occlusion strokes, as demonstrated by Goyal et al. in a paper recently published in this Journal [2]. Therefore, according to Nam et al [1], patients with acute ischemic stroke and a higher NLR would be older, with a higher initial National Institutes of Health Stroke Scale (NIHSS), dysphagic and with a higher A2DS2 score. We would be interested to see the occurrence of SAP in patients older than 75 years, as compared with younger people, and whether the association between SAP and NLR is closer in this subset of patients as compared with younger people. These data would further strengthen the accordance of the results of Nam et al [1] with previous findings from our group [3], demonstrating that NLR is a prognostic tool for community-acquired pneumonia (CAP) in elderly adults, predicting 30-day mortality and 3-month re-hospitalization better than traditional scores. Of note, our observational study [3] showed that age and NLR would both act synergistically to predict the presence and the severity of an inflammatory state, usually associated with CAP and aging. Moreover, in keeping with these findings are our recent data [4] showing an intriguing association between NLR and carotid atherosclerotic plaques in older patients, so emphasizing the link between aging, inflammation and carotid atherosclerosis. Moreover, it would be interesting to see whether in the study of Nam et al. [1] are available data on the presence of carotid plaques, their number and characteristics (stable, unstable), at least in patients experiencing SAP. This could allow to assess the association between NLR and carotid atherosclerosis even in patients with SAP, as already shown in our patients with CAP [3]. If this link is confirmed, facing patients with SAP, namely an association of two major conditions of hospitalization for older people, often responsible of either a higher mortality or a long-term disability, it would be emphasized the role of NLR as simple and useful tool to quickly assess the frailty state and predict the outcome. Therefore, interventional studies should be encouraged to confirm the role of NLR as an emerging tool predicting outcome as related to the response to antibiotics and anti-inflammatory drugs in patients with SAP.

Letter by Buonacera et al Regarding Article, "High Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Pneumonia"

BUONACERA, AGATA
Membro del Collaboration Group
;
Corriere, Thea
Membro del Collaboration Group
;
Malatino, Lorenzo
2018

Abstract

To the Editor, We read with great interest the recent article by Nam et al [1], focused on the association between the neutrophil-to-lymphocyte ratio (NLR) and the stroke-associated pneumonia (SAP) in patients with acute ischemic stroke. NLR correlates with both pneumonia and stroke severity indexes in patients with acute ischemic stroke vulnerable to pneumonia. Although the design as 2-center retrospective study would limit the generalization of the results, the Authors [1] intriguingly emphasized the potential role of NLR as a marker of higher risk for developing SAP. This further strengthens the role of admission NLR as short- and long-term outcome predictor in acute ischemic stroke, especially large vessel occlusion strokes, as demonstrated by Goyal et al. in a paper recently published in this Journal [2]. Therefore, according to Nam et al [1], patients with acute ischemic stroke and a higher NLR would be older, with a higher initial National Institutes of Health Stroke Scale (NIHSS), dysphagic and with a higher A2DS2 score. We would be interested to see the occurrence of SAP in patients older than 75 years, as compared with younger people, and whether the association between SAP and NLR is closer in this subset of patients as compared with younger people. These data would further strengthen the accordance of the results of Nam et al [1] with previous findings from our group [3], demonstrating that NLR is a prognostic tool for community-acquired pneumonia (CAP) in elderly adults, predicting 30-day mortality and 3-month re-hospitalization better than traditional scores. Of note, our observational study [3] showed that age and NLR would both act synergistically to predict the presence and the severity of an inflammatory state, usually associated with CAP and aging. Moreover, in keeping with these findings are our recent data [4] showing an intriguing association between NLR and carotid atherosclerotic plaques in older patients, so emphasizing the link between aging, inflammation and carotid atherosclerosis. Moreover, it would be interesting to see whether in the study of Nam et al. [1] are available data on the presence of carotid plaques, their number and characteristics (stable, unstable), at least in patients experiencing SAP. This could allow to assess the association between NLR and carotid atherosclerosis even in patients with SAP, as already shown in our patients with CAP [3]. If this link is confirmed, facing patients with SAP, namely an association of two major conditions of hospitalization for older people, often responsible of either a higher mortality or a long-term disability, it would be emphasized the role of NLR as simple and useful tool to quickly assess the frailty state and predict the outcome. Therefore, interventional studies should be encouraged to confirm the role of NLR as an emerging tool predicting outcome as related to the response to antibiotics and anti-inflammatory drugs in patients with SAP.
Neurology (clinical); Cardiology and Cardiovascular Medicine; Advanced and Specialized Nursing
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/359717
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