The Comparison of The Prognostic Performance of Tumor Necrosis Factor-Alpha and Neutrophil-To-Lymphocyte Ratio (NLR) on Clinical Outcomes In Acute Ischemic Stroke Patients

Acute ischemic stroke is a leading cause of long-term disability and mortality, with inflammation playing a critical role in its pathogenesis. This study evaluated the association between two inflammatory biomarkers—Neutrophil-to-Lymphocyte Ratio (NLR) and Tumor Necrosis Factor-α (TNF-α)—with stroke severity and functional outcomes. A total of 55 patients with acute ischemic stroke were enrolled. Stroke severity was assessed using the NIH Stroke Scale (NIHSS), while functional outcomes were measured with the modified Rankin Scale (mRS) at admission and 30 days post-stroke. NLR showed a significant positive correlation with both NIHSS and mRS scores, with higher values in patients experiencing more severe strokes and poorer outcomes. Receiver operating characteristic (ROC) analysis demonstrated fair predictive ability of NLR for unfavorable outcomes, with an AUC of 0.708 (p=0.007), sensitivity of 75.0%, and specificity of 65.2% at the optimal cut-off of 4.81. In comparison, TNF-α showed weaker correlations with clinical scores and lower diagnostic performance, with an AUC of 0.658 (p=0.031), sensitivity of 71.9%, and specificity of 60.9% at the optimal cut-off of 4.43. In conclusion, NLR was strongly associated with stroke severity and functional outcomes, demonstrating better predictive accuracy than TNF-α. Given its higher AUC, sensitivity, and specificity, NLR appears to be a practical and accessible biomarker for early risk stratification in acute ischemic stroke, while TNF-α may serve as a complementary indicator of inflammation.