A novel nomogram to predict early neurological deterioration in patients with acute ischaemic stroke

Liu

et al. 2020

Preprint

Background and Purpose: To investigate the association of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS).Methods: AIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as National Institutes of Health Stroke Scale (NIHSS) score increase of ≥4 within 24 hours after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥4 or complete recovery within 24 hours. Multivariable logistic regression analyses were performed to explore the relationship of NLR, PLR and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI.Results: Among 1060 recruited patients, a total of 193 (18.2%) were diagnosed with ENI and 398 (37.5%) were diagnosed with END. Multivariable logistic models indicated that NLR (odds ratio [OR], 1.652; 95% confidence interval [CI] 1.510-1.807, P=0.001) and PLR (OR, 1.015; 95% CI 1.012-1.018, P=0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.686; 95% CI 0.631-0.745, P=0.001), PLR (OR, 0.997; 95% CI 0.994-0.999, P=0.006) and LMR (OR, 1.170; 95% CI 1.043-1.313, P=0.008) served as independent factors for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR and LMR to discriminate END were 0.763, 0.703 and 0.551, respectively. AUC of NLR, PLR and LMR to discriminate ENI were 0.695, 0.530 and 0.547, respectively.Conclusions: NLR and PLR were associated with and may predict post-thrombolysis END. NLR, PLR and LMR were related to post-thrombolysis ENI.

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 98%

The Association of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio With Post-Thrombolysis Early Neurological Outcomes in Patients With Acute Ischemic Stroke

Liu

et al. 2020

Preprint

“…It is reported that in ammation may be related to central nervous system diseases, such as stroke, Parkinson's Disease and Alzheimer disease, and plays a crucial role in the mechanism [9][10][11][12] . Gong and his colleagues found the association between high-sensitivity C-reactive protein at admission and progressive motor de cits in patients with penetrating artery infarctions [13] . Previous studies also discovered that albumin might be able to attenuate excessive innate immunity in subarachnoid hemorrhage [14,15] .…”

Section: Introductionmentioning

confidence: 99%

Hypersensitive C-Reactive Protein-Albumin Ratio Predicts Symptomatic Intracranial Hemorrhage After Endovascular Therapy in Acute Ischemic Stroke Patients

Peng¹,

Hou²,

Wang³

et al. 2020

Preprint

Background and purpose: A fraction of patients would develop symptomatic intracranial hemorrhage (sICH) after endovascular therapy. The aim of our study was to explore the ability of hypersensitive C-reactive protein-albumin ratio (HAR) in predicting sICH after endovascular therapy.Methods: From April 2016 to December 2018, 334 consecutive patients with anterior circulation infarction undergoing endovascular therapy were enrolled in our study. sICH was defined as a National Institutes of Health Stroke Scale score increase of ≥ 4 points within 24 hours after endovascular therapy. Multiple regression analysis was used to investigate the potential risk factors of sICH after endovascular therapy. We used receiver operating characteristic curve analysis and nomogram analysis to assess the overall discriminative ability of the HAR in predicting sICH after endovascular therapy.Results: Among these 334 patients enrolled, 37 (11.1%) patients with anterior circulation infarction were identified with sICH after endovascular therapy. Univariate logistic regression analysis demonstrated that patients with higher levels of HAR may be inclined to develop sICH [odds ratio, 10.994; 95% confidence interval (CI), 4.567–26.463; P = 0.001]. This association remained significant even after adjustment for potential confounders. Also, a cutoff value of 0.526×10-3 for HAR was detected in predicting sICH (area under curve, 0.763). Furthermore, nomogram analysis also suggested that HAR was an indicator of sICH (c-index was 0.890, P<0.001).Conclusions: This study showed that high levels of HAR may predict sICH after endovascular therapy.

“…The reported frequency of END in AIS varies widely, ranging from 5-40% [5][6][7][8]. Previous studies have revealed some of the main clinical and radiological factors predicting END, including high blood glucose levels, older age, more severe stroke, history of diabetes, coronary heart disease, nonuse of aspirin, high levels of high-sensitivity C-reactive protein, no recanalization, re-occlusion, brain swelling, and the presence of an infarction > 1/3 of the middle cerebral artery territory [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Effects of Early Neurological Deterioration in Acute Ischemic Stroke on Multiple Dimensions of Functional Outcomes using Propensity Score Matching Analysis

Qu¹,

Zhong²,

Liang³

et al. 2020

Preprint

Background: Early neurological deterioration (END) is common in acute ischemic stroke (AIS), but its effect on functional outcomes is not well understood. Here, we explored the effects of END on multiple dimensions of functional outcomes.Methods: 256 patients with AIS were analyzed. All patients were followed up for 1 year. We used the modified Rankin Scale (mRS) to assess body function impairment, the Lawton activities of daily living scale to assess activity limitations, and the reintegration to normal living index (RNLI) to assess participation restrictions. Brain MRI was performed to identify acute infarcts and preexisting abnormalities. To reduce the effects of a lack of randomization, we conducted a propensity score analysis. Results: Among 256 patients with AIS, 61(23.8%) patients had END. Before matching, patients with END had higher levels of small artery-type stroke, higher NIHSS scores on arrival, higher systolic blood pressure on admission, and larger infarct volumes. After matching, there were no significant differences between the two groups in any clinical or neuroimaging variables, except for stroke subtype and cortical region infarct. Logistic regression analysis revealed that END was a significant predictor of poor mRS (odds ratio [OR], 3.829; 95% confidence interval [CI], 1.367–10.723, p = 0.011) and poor RNLI (OR, 2.777; 95% CI, 1.133–6.806, p = 0.026) scores after adjusting for confounding factors.Conclusions: END is relatively common in AIS. END might be a significant predictor of poor functional outcomes, including body function impairment and reduced social participation.