ANALYSIS OF COMPLETE BLOOD COUNT, CBC-DERIVED RATIOS, AND INFLAMMATORY INDICES IN THE DIAGNOSIS OF STROKE TYPES

Riskullah Makmur (Department of Clinical Pathology, Faculty of Medicine, Universitas Hasanuddin, Makassar)
Darwati Muhadi (Department of Clinical Pathology, Faculty of Medicine, Universitas Hasanuddin, Makassar/Dr. Wahidin Sudirohusodo General Hospital, Makassar)
Mansyur Arif (Department of Clinical Pathology, Faculty of Medicine, Universitas Hasanuddin, Makassar/Dr. Wahidin Sudirohusodo General Hospital, Makassar)

Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
Vol. 32 No. 3 (2026)

Early differentiation between non-hemorrhagic stroke (NHS) and hemorrhagic stroke (HS) is crucial for appropriate management. However, access to neuroimaging remains restricted in many clinical settings. Complete blood count (CBC) parameters, CBC-derived ratios, and inflammatory indices may offer a rapid and accessible alternative for early diagnosis of stroke types. This study aimed to determine the differences and diagnostic value of the CBC ratio, and CBC-derived inflammatory indices in the early diagnosis of stroke types. This cross-sectional study used secondary data from the medical records of patients with their first acute stroke, treated in the Emergency Department of Wahidin Sudirohusodo Hospital, Makassar, between January 2019 and September 2024. All included subjects underwent a complete blood count (CBC) and either a head Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) as the diagnostic gold standard. Statistical analysis was performed using SPSS software (version 26.0), employing comparative tests and diagnostic accuracy assessments to evaluate the parameters. A total of 260 stroke patients (144 NHS and 116 HS) were included. The results showed that the values of LYM, EOS, LWR, LMR, EWR, EMR, PWR, and PMR were significantly higher in NHS than in HS (p<0.05). The values of HCT, WBC, NEU, MON, MLR, NLR, dNLR, NMLR, NLPR, WPR, SIRI, SII, and AISI were significantly higher in HS than in NHS (p<0.05). The ROC analysis showed that the values of PWR (AUC=72.7%) with optimal cut-off 19.91 (Sensitivity=83.3%; Specificity=55.2%; PPV=69.8%; NPV=72.7%), WPR (AUC=72.7%) with optimal cut-off 0.05 (Sensitivity=77.1%; Specificity=59.5%; PPV=70.3%; NPV=67.7%), NEU (AUC=71.5%) with optimal cut-off 7.35 (Sensitivity=60.4%; Specificity=75.0%; PPV=75.0%; NPV=60.4%) and WBC (AUC=70.1%) with optimal cut-off 10.15 (Sensitivity=56.2%; Specificity=75.0%; PPV=73.6%; NPV=58.0%) can be a biomarker to differentiate NHS and HS with moderate diagnostic value (AUC=70-80%). This study supports the utility of CBC parameters, CBC-derived ratios, and inflammation indices as potential alternative tools for the early differentiation of acute stroke types.