Abstract
Background
Neutrophil-to-lymphocyte ratio (NLR) has been used as a predictive marker for various
conditions. However, there are no previous studies about NLR as a prognostic marker
for acute infarction.
Objective
To evaluate the potential utility of NLR as a predictor of acute infarction in acute
vertigo patients without neurologic and computed tomography (CT) abnormalities.
Methods
We conducted a prospective, observational study in the Emergency Department (ED) between
January 2015 and December 2016. All patients underwent physical examination, laboratory
tests, CT, and magnetic resonance imaging (MRI). Results of the initial and follow-up
MRI with clinical progress note were considered as the reference standard. Statistically,
multivariate logistic regression analysis and receiver operating characteristic (ROC)
curve were used.
Results
Thirty-five (25.9%) patients were diagnosed with acute infarction and 100 (74.1%)
patients were diagnosed with peripheral vertigo. Horizontal nystagmus (p = 0.03; odds ratio 0.22) and NLR (p = 0.03; odds ratio 5.4) were significant factors for the differential diagnosis of
acute infarction and peripheral vertigo. NLR > 2.8 showed the greatest area under
the ROC curve (AUC; 0.819), optimal sensitivity (85.7%), and specificity (78.0%).
NLR > 1.4 showed the highest sensitivity (97.1%) and relatively low specificity (41%).
The absence of horizontal nystagmus increased the specificity (81.0%) and AUC (0.844).
Conclusions
A combination of NLR > 2.8 and the absence of horizontal nystagmus is sufficiently
specific for acute infarction in an ED patient with acute vertigo; thus, further testing
with MRI is indicated. NLR < 2.8 by itself or combined with the presence of horizontal
nystagmus is not sufficiently sensitive to rule out the need for further testing.
Keywords
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Article info
Publication history
Published online: February 01, 2018
Accepted:
December 30,
2017
Received in revised form:
December 4,
2017
Received:
August 30,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
