Neutrophil‐Monocyte‐to‐Lymphocyte Ratio as a Valid Prognostic Tool for Acute Ischemic Stroke With Performance Comparable to Neutrophil‐to‐Lymphocyte Ratio

BACKGROUND: Inflammation is a key mediator for brain injury in acute ischemic stroke (AIS) and the neutrophil-monocyte-to-lymphocyte ratio (NMLR) is a novel composite index for inflammatory. So far, prior studies have not evaluated the prognostic value of NMLR for 3-month functional outcomes in patients with AIS, nor systematically compared its performance with established markers, such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and individual cellular components. This prospective cohort study aims to address these research gaps. METHODS: A total of 815 consecutive patients with AIS hospitalized between December 2023 and May 2024 were enrolled. Baseline clinical data and blood samples were collected within 24 h of admission. The primary outcome was poor 90-day functional outcome (modified Rankin Scale score > 2). Multivariable logistic regression determined adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the outcome association of NMLR. Receiver operating characteristic (ROC) curve analysis compared the predictive performance (area under the curve [AUC]) of NMLR with NLR, MLR, and individual cellular components. RESULTS: Of the 815 patients, 224 (27.5%) had poor functional outcomes. After adjusting for confounders, higher NMLR was independently associated with increased risk of poor outcomes (aOR = 1.370 per unit increase, 95% CI: 1.214-1.546; p < 0.001). NMLR's predictive performance (AUC = 0.708, 95% CI: 0.668-0.749) was statistically equivalent to NLR (AUC = 0.709, p = 0.594), but significantly superior to MLR and individual cellular components (all p < 0.05). CONCLUSIONS: This is the first prospective study to assess the predictive value of the NMLR for 3-month functional outcomes in patients with AIS and systematically compare NMLR with NLR. NMLR can predict poor 90-day outcomes in patients with AIS independently. NMLR is a valid prognostic tool for AIS with performance comparable to NLR.