SavedAdd your journal

Journals / Osmangazi Tıp Dergisi / 2026 / Cilt: 48 Sayı: 3

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

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

Nazlı Kenan(Konya şehir hastanesi)0000-0002-0773-3384
Emine Doğan(Konya Şehir Hastanesi)0000-0002-8789-6705
Asiye Müminat Çap(Konya Şehir Hastanesi)0009-0000-9296-9502
Emine Kadıoğlu(Konya Şehir Hastanesi)0000-0003-0950-0477
Yavuz Yılmaz(Konya Şehir Hastanesi)0009-0009-9116-7570
Demet Acar(Konya Şehir Hastanesi)0009-0000-4748-4733
Pages
514–523
Publication Date
2026-05-12
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

GPR was associated with ischemic stroke, whereas both markers were linked to hemorrhagic stroke, suggesting complementary pathophysiological roles.

📌 3 Key Takeaways

🎯
Objective & Hypothesis: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.
📊
Key Findings & Data:This retrospective study included 475 participants (286 stroke, 189 controls).
💡
Conclusion & Impact:GPR was associated with ischemic stroke, whereas both markers were linked to hemorrhagic stroke, suggesting complementary pathophysiological roles.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:Serebrovasküler olay · glikoz-potasyum oranı · inflamasyon

Abstract

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.

Özet

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.

🔖

Cite This Article

Kenan, N., Doğan, E., Çap, A. M., Kadıoğlu, E., Yılmaz, Y., Acar, D. (2026). Inflammatory and Metabolic Markers in Stroke: Diagnostic and Prognostic Associations of NLR and GPR. Osmangazi Tıp Dergisi, Cilt: 48 Sayı: 3, 514–523. https://doi.org/10.20515/otd.1798641

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (31)

  1. Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res. 2017;120(3):439-48.
  2. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439-58.
  3. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008;371(9624):1612-23.
  4. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021;143(8):e254-e743.
  5. Campbell BCV, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Primers. 2019;5(1):70. 6. Murphy SJ, Werring DJ. Stroke: causes and clinical features. Medicine (Abingdon). 2020;48(9):561-6.
  6. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167-76.
  7. Kelly PJ, Lemmens R, Tsivgoulis G. Inflammation and Stroke Risk: A New Target for Prevention. Stroke. 2021;52(8):2697-706.
  8. Dirnagl U, Klehmet J, Braun JS, Harms H, Meisel C, Ziemssen T, et al. Stroke-induced immunodepression: experimental evidence and clinical relevance. Stroke. 2007;38(2 Suppl):770-3.
  9. Chamorro Á, Meisel A, Planas AM, Urra X, van de Beek D, Veltkamp R. The immunology of acute stroke. Nat Rev Neurol. 2012;8(7):401-10.
  10. Paudel SS, Thapa B, Luitel R. Neutrophil Lymphocyte Ratio as a Prognostic Marker in Acute Ischemic Stroke: a Systematic Review and Meta-analysis. J Nepal Health Res Counc. 2021;18(4):573-9.
  11. Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med. 2020;38(3):641-7.
  12. Cupp MA, Cariolou M, Tzoulaki I, Aune D, Evangelou E, Berlanga-Taylor AJ. Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies. BMC Med. 2020;18(1):360.
  13. Acar D, Kadıoğlu E, Kenan N, Doğan E, Çap AM, Yılmaz Y. The Glucose/Potassium Ratio Exhibits a Predictive Role That is Both Earlier and More Efficacious Compared to The İnflammatory Response in The Context of Isolated Thoracic Trauma. Genel Tıp Dergisi.34(3).
  14. Kadıoğlu E, Karaman S, Acar D, Doğan E, Karakus Kenan N, Cap AM, et al. The new biomarker that predicts in-hospital mortality in myocardial infarction: glucose/potassium ratio. Intercontinental Journal of Emergency Medicine. 2024;2(1):6-10.
  15. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage. Stroke. 2016;47(6):1654-7.
  16. Lattanzi S, Brigo F, Trinka E, Cagnetti C, Di Napoli M, Silvestrini M. Neutrophil-to-Lymphocyte Ratio in Acute Cerebral Hemorrhage: a System Review. Transl Stroke Res. 2019;10(2):137-45.
  17. Zhang Y, Jiang L, Yang P, Zhang Y. Comparison of Lymphocyte Count, Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting the Severity and the Clinical Outcomes of Acute Cerebral Infarction Patients. Clin Lab. 2019;65(7).
  18. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32(10):2426-32.
  19. Lu Y, Ma X, Zhou X, Wang Y. The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients. Scientific Reports. 2022;12(1):8233.
  20. Yan X, Wu D, Xu X, Zhang A, Liao J, He Q, et al. Relationship between serum glucose-potassium ratio and 90-day outcomes of patients with acute ischemic stroke. Heliyon. 2024;10(17):e36911.
  21. Demir FA, Ersoy İ, Yılmaz A, Taylan G, Kaya EE, Aydın E, et al. Serum glucose-potassium ratio predicts inhospital mortality in patients admitted to coronary care unit. Rev Assoc Med Bras (1992). 2024;70(10):e20240508.
  22. Boyuk F. The Predictor Potential Role of the Glucose to Potassium Ratio in the Diagnostic Differentiation of Massive and Non-Massive Pulmonary Embolism. Clin Appl Thromb Hemost. 2022;28:10760296221076146.
  23. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112-23.
  24. Moretti A, Ferrari F, Villa RF. Neuroprotection for ischaemic stroke: current status and challenges. Pharmacol Ther. 2015;146:23-34.
  25. Li W, Hou M, Ding Z, Liu X, Shao Y, Li X. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Stroke: A Systematic Review and Meta-Analysis. Front Neurol. 2021;12:686983.
  26. Xu C, Cai L, Yi T, Yi X, Hu Y. Neutrophil-to-lymphocyte ratio is associated with stroke progression and functional outcome in patients with ischemic stroke. Brain Behav. 2023;13(11):e3261.
  27. Wan J, Wang X, Zhen Y, Chen X, Yao P, Liu W, et al. The predictive role of the neutrophil-lymphocyte ratio in the prognosis of adult patients with stroke. Chin Neurosurg J. 2020;6:22.
  28. Wang L, Song Q, Wang C, Wu S, Deng L, Li Y, et al. Neutrophil to lymphocyte ratio predicts poor outcomes after acute ischemic stroke: A cohort study and systematic review. J Neurol Sci. 2019;406:116445.
  29. Huang YW, Li ZP, Yin XS. Stress hyperglycemia and risk of adverse outcomes in patients with acute ischemic stroke: a systematic review and dose-response meta-analysis of cohort studies. Front Neurol. 2023;14:1219863.
  30. Wu XY, Zhuang YK, Cai Y, Dong XQ, Wang KY, Du Q, et al. Serum glucose and potassium ratio as a predictive factor for prognosis of acute intracerebral hemorrhage. J Int Med Res. 2021;49(4):3000605211009689.
  31. Lu Y, Ma X, Zhou X, Wang Y. The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients. Sci Rep. 2022;12(1):8233.