Abstract
OBJECTIVE: To determine whether differences in lymphocyte-related inflammatory markers in the ultra-early phase of stroke (within 24 hours of onset) are associated with post-stroke cognitive impairment in the early recovery phase (within 30 days of stroke onset), and to further assess the predictive value of these markers. METHODS: The study population consisted of patients who underwent rehabilitation treatment at the Rehabilitation Department of Hebei University Affiliated Hospital between December 2024 and June 2025, within 30 days of stroke onset, ie, during the early recovery phase of stroke. Patients were grouped based on whether they developed cognitive impairment. A retrospective analysis was conducted of patients' blood markers and neurological deficit scores within 24 hours of stroke onset to examine the relationship between ultra-early blood markers and neurological deficits and post-stroke cognitive impairment. RESULTS: There were no significant differences in baseline data between the two groups. However, the proportion of hemorrhagic stroke patients was significantly higher in the PSCI group than in the non-PSCI group (39.7% vs 18.8%, P=0.026<0.05). NLR and NIHSS scores showed significant differences between the two groups. Multivariate analysis indicated that NIHSS (OR=1.297, 95% CI: 1.167-1.442, p<0.001) was independently associated with PSCI, while NLR (OR=1.107, 95% CI: 0.995-1.231, p=0.063) showed a borderline association with PSCI. MLR showed differences between the two groups in univariate analysis (P=0.018) but was excluded in multivariate analysis. ULR did not show significant differences. CONCLUSION: NIHSS is a strong predictive factor (P < 0.05), with a cut of value of 12 calculated by the ROC curve. NLR is at the threshold for an independent risk factor. Subsequent ROC curves indicate that NLR has low diagnostic sensitivity but high specificity, making it more suitable for screening rather than diagnostic use. MLR and ULR did not demonstrate high predictive value; further studies should be conducted to expand the sample size, perform subgroup analyses, and increase follow-up.