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Vol. 38 No. 2 Maret 2021

HUBUNGAN NEUTROPHIL TO LYMPHOCYTE RATIO SEBAGAI FAKTOR PREDIKTIF DEFISIT NEUROLOGIS PADA PASIEN STROKE ISKEMIK AKUT
Adrian Djatikusumo,* Poppy Kristina Sasmita,** Bryany Titi Santi**

CORRELATION BETWEEN NEUTROPHIL TO LYMPHOCYTE RATIO AS PREDICTIVE FACTOR OF NEUROLOGICAL DEFICIT IN ACUTE ISCHEMIC STROKE PATIENTS

ABSTRACT

Introduction: Stroke is defined as a neurological deficit with sudden onset associated with focal and global vascular causes, which leads to morbidity and mortality. In all stages of acute ischemic stroke, an inflammatory process occurs, which is mediated by neutrophils or lymphocytes.

Aim: To determine the correlation between neutrophil to lymphocyte ratio (NLR) with neurological deficits or functional outcomes in acute ischemic stroke patients.

Methods: This study was conducted using a systematic review method. The studies, filtered through various databases, were assessed for quality and risk of bias using the Newcastle-Ottawa Scale (NOS). Stroke severity and neurological deficits were assessed using the National Institutes of Health Stroke Scale (NIHSS), Scandinavian Stroke Scale (SSS) and modified Rankin Scale (mRS).

Results: There were seven studies that met the criteria for the literature search and were assessed as having high quality based on NOS. All included studies stated that there was a significant relationship between NLR and poor stroke functional outcomes in acute ischemic stroke patients (p-value <0.05). The cutoff value of the NLR on the neurological deficits of acute ischemic stroke patients ranged from 2.39 to 4.58 with varying sensitivity and specificity.

Discussion: The variations of cutoff, sensitivity and specificity of NLR in predicting neurological deficits could be influenced by the number and characteristics of the sample, race, comorbidity and inclusion and exclusion criteria in the included articles. The significant relationship between NLR and neurological deficits is based on an inflammatory process that occurs at all stages of acute ischemic stroke.

Keywords: acute ischemic stroke, functional outcomes, neurological deficits, NLR.

ABSTRAK

Pendahuluan: Stroke didefinisikan sebagai defisit neurologis dengan onset mendadak terkait penyebab vaskuler baik bersifat fokal maupun global, yang dapat menyebabkan morbiditas maupun mortalitas. Dalam semua tahap stroke iskemik akut, terjadi proses inflamasi yang salah satunya dimediasi oleh neutrofil maupun limfosit.

Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan neutrophil to lymphocyte ratio (NLR) dengan defisit neurologis atau keluaran fungsional pasien stroke iskemik akut.

Metode: Penelitian ini dilakukan dengan metode telaah sistematis. Studi yang disaring melalui berbagai database, dinilai kualitas dan risiko biasnya mengunakan Newcastle-Ottawa Scale (NOS). Parameter derajat keparahan stroke dan defisit neurologis dinilai dengan National Institutes of Health Stroke Scale (NIHSS), Scandinavian Stroke Scale (SSS), dan modified Rankin Scale (mRS).

Hasil: Didapatkan tujuh studi yang memenuhi kriteria pencarian literatur dan dinilai memiliki kualitas tinggi berdasarkan NOS. Seluruh studi yang diinklusi menyatakan bahwa terdapat hubungan bermakna antara NLR dengan keluaran fungsional stroke yang buruk pada pasien stroke iskemik akut (nilai p <0,05). Nilai cutoff dari NLR terhadap defisit neurologis pasien stroke iskemik akut beragam mulai dari 2,39-4,58 dengan sensitivitas dan spesifisitas yang bervariasi.

Diskusi: Adanya variasi cutoff, sensitivitas, dan spesifisitas NLR dalam memprediksi defisit neurologis dapat dipengaruhi oleh jumlah dan karakteristik sampel, ras, komorbiditas, serta kriteria inklusi dan eksklusi pada artikel yang diinklusi. Hubungan bermakna antara NLR dengan defisit neurologis didasari oleh proses inflamasi yang terjadi pada seluruh tahap stroke iskemik akut.

Kata kunci: defisit neurologis, keluaran fungsional, NLR, stroke iskemik akut.

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