Neutrophil-to-lymphocyte ratio as a risk factor for prolonged hospital stay in stroke: The Peru-Casimiro study

Background: The neutrophil-to-lymphocyte ratio (NLR) is an accessible biomarker of systemic inflammation with potential prognostic utility in cerebrovascular disease (CVD). Its relationship with prolonged hospitalization in stroke remains insufficiently explored in Peruvian populations. Aims: To evaluate whether the NLR at admission is associated with prolonged hospital stay (≥ 9 days) in patients with ischemic and hemorrhagic CVD treated at Hospital de Emergencias José Casimiro Ulloa (2022–2024) Methods: A retrospective observational study was performed including 227 adults with confirmed CVD. Clinical, demographic, and laboratory data were retrieved from medical records. Optimal NLR cut-offs were determined using RO1C curve analysis. Logistic regression models—stratified by stroke subtype—assessed associations between NLR and prolonged hospitalization, adjusting for relevant clinical variables and collinearity. Results: Among 227 patients, 61.7% had ischemic and 38.3% hemorrhagic CVD. Prolonged stay occurred in 21.4% of ischemic and 54.0% of hemorrhagic cases. ROC analysis identified optimal NLR cut-offs of 3.16 (ischemic; AUC = 0.738) and 3.18 (hemorrhagic; AUC = 0.616). In ischemic CVD, NLR was the only independent predictor of prolonged stay (adjusted OR = 1.173; p = 0.005). No variable, including NLR, independently predicted prolonged hospitalization in hemorrhagic CVD. Conclusions: Admission NLR may be an independent predictor of prolonged hospital stay in ischemic but not hemorrhagic stroke. NLR may support early risk stratification in resource-limited emergency settings. Prospective studies incorporating standardized stroke severity measures are needed.