Association of platelet-to-white blood cell ratio and platelet-to-neutrophil ratio with the risk of fatal stroke occurrence in middle-aged to older Chinese

Zhi-Bing Hu; Qiong-Qiong Zhong; Ze-Xiong Lu; Feng Zhu

doi:10.1186/s12877-022-03134-z

Association of platelet-to-white blood cell ratio and platelet-to-neutrophil ratio with the risk of fatal stroke occurrence in middle-aged to older Chinese

BMC Geriatr. 2022 May 17;22(1):430. doi: 10.1186/s12877-022-03134-z.

Authors

Zhi-Bing Hu^#¹, Qiong-Qiong Zhong^#^{1

2}, Ze-Xiong Lu³, Feng Zhu⁴

Affiliations

¹ Department of Internal Medicine and Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China.
² Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Jinan, China.
³ Department of Internal Medicine, Sanya Central Hospital, Sanya, China.
⁴ Department of Internal Medicine and Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China. chifengzhu@hotmail.com.

^# Contributed equally.

Abstract

Background: White blood cell (WBC) and neutrophil (NEUT) counts, which are commonly inflammatory markers, have been related to an increased risk of fatal stroke. However, it is unclear whether platelet-to-white blood cell ratio (PWR) and platelet-to-neutrophil ratio (PNR) are related to the risk of fatal stroke in middle-aged to older populations.

Method: In total, 27,811 participants without a stroke history at baseline were included and followed up for a mean of 14.3 years (standard deviation = 3.2), and 838 stroke deaths were recorded. The Cox proportional hazards regression was used to assess the relationships between the PWR and the PNR and the risk of fatal strokes.

Results: Compared to the 1^st quartile, an increased risk of fatal all stroke showed among the participants in the highest quartiles of both the WBC (adjusted hazard ratio (aHR) = 1.35, 95% confidence interval (CI) 1.09-1.66) and the NEUT (aHR = 1.45, 95% CI 1.18-1.79). The restricted cubic splines showed decreased trends in associations of the PWR and the PNR with the risk of fatal all stroke. A decreased risk of fatal all stroke showed in those with the highest quartiles for both the PWR (aHR = 0.73, 95% CI 0.53-1.00) and the PNR (aHR = 0.74, 95% CI 0.54-1.01). The participants with the 2^nd, the 3^rd and the 4^th change quartiles for the PWR and the PNR had weak decreasing trends for the risk of fatal all stroke, compared to those in the 1^st change quartile, and the significant associations were observed in those with an increase of 20% for the PWR with the risk of fatal haemarragic stroke (aHR = 0.47, 95% CI 0.22-0.95) and a decrease of 20% for the PNR with the risk of fatal all stroke (aHR = 1.33, 95% CI 0.99-1.79), compared to those with stable dynamic changes.

Conclusions: Higher neutrophil count and platelet-to-neutrophil ratio were associated with a contrary risk of fatal stroke, with an increased for the former and a decreased for the later. A potentially chronic inflammation should be paid close attention to stroke occurrence in relatively healthy middle-aged to older populations.

Keywords: Haemorrhagic; Ischaemic; Neutrophil; Platelet; Stroke; White blood cell.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
Humans
Leukocyte Count
Leukocytes
Middle Aged
Neutrophils*
Stroke* / diagnosis
Stroke* / epidemiology