Association Between Neutrophil-to-Lymphocyte Ratio/Lymphocyte-to-Monocyte Ratio and In-Hospital Clinical Outcomes in Ischemic Stroke Treated with Intravenous Thrombolysis

Abstract

Objective Investigations on neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in patients with ischemic stroke are insufficient. We aimed to investigate the relationship of NLR and LMR with in-hospital clinical outcomes at different time points in ischemic stroke patients treated with intravenous tissues plasminogen activator (IV tPA). Methods We retrospectively enrolled patients who received IV tPA therapy within 4.5 hours from symptoms onset. Demographics, clinical characteristics, imaging measures, and the in-hospital clinical outcomes including early neurological improvement (ENI, defined as NIHSS score reduction within 24 hours ≥4 points or decreased to the baseline) and favorable functional outcome (defined as modified Rankin scale 0–1) were collected. Multivariable logistic regression analyses were performed to test whether NLR or LMR was an independent predictor for the in-hospital clinical outcomes. Results One hundred and two patients treated with IV tPA were included. NLR at 24 hours proved to be an independent predictor of ENI (adjusted OR=0.85, 95% CI=0.75–0.95, P =0.04). NLR at 48 hours and LMR at 48 hours proved to be independent predictors of mRS 0–1 at discharge (NLR at 48 hours: adjusted OR=0.64, 95% CI=0.49–0.83, P =0.01; LMR at 48 hours: adjusted OR=1.50, 95% CI=1.08–2.09, P =0.02). The AUC of NLR at 48 hours to predict favorable functional outcome at discharge was 0.79 (95% CI=0.70–0.88, P <0.001) and the optimal cut-off was 5.69 (sensitivity=0.52, specificity=0.63). Conclusion In our study, NLR at 24 hours was correlated with ENI. Both NLR and LMR at 48 hours were closely associated with favorable functional outcomes at discharge.

The Association of the Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio and Systemic Inflammation Response Index with Short-Term Functional Outcome in Patients with Acute Ischemic Stroke

“… 27 Li et al demonstrated that the LMR 48 h after intravenous thrombolysis can be used as a biomarker of the functional outcome of discharged patients with AIS. 28 Our findings suggest that a low LMR increases the incidence of poor functional outcomes in AIS patients at discharge. This may be the first time that a correlation has been proposed between LMR at admission and functional outcome at discharge in patients with AIS.…”

Neutrophil‐to‐lymphocyte ratio and its changes predict the 3‐month outcome and mortality in acute ischemic stroke patients after intravenous thrombolysis

“…NLRs, calculated from neutrophils and lymphocytes, were found to be closely related to the effects of neutrophils and lymphocytes on stroke and their interaction mechanisms (Brooks et al., 2014 ; Li et al., 2022 ; Parikh et al., 2020 ; Ramiro et al., 2018 ). Prior studies showed that NLR was used to predict the prognosis of patients with AIS after thrombolysis in stroke patients (Brooks et al., 2014 ; Li et al., 2022 ; Maestrini et al., 2015 ).…”

“…NLRs, calculated from neutrophils and lymphocytes, were found to be closely related to the effects of neutrophils and lymphocytes on stroke and their interaction mechanisms (Brooks et al., 2014 ; Li et al., 2022 ; Parikh et al., 2020 ; Ramiro et al., 2018 ). Prior studies showed that NLR was used to predict the prognosis of patients with AIS after thrombolysis in stroke patients (Brooks et al., 2014 ; Li et al., 2022 ; Maestrini et al., 2015 ). Most studies have collected the NLR value at several time points within 7 days after IVT (generally at admission, 24, 48 h, and 7 days) (Chu et al., 2020 ; Guo et al., 2016 ) and found that NLR level increased after stroke onset and reached the peak at 12–48 h (Li et al., 2022 ; Sadeghi et al., 2022 ; Shi et al., 2018 ; Weng et al., 2021 ).…”

“…Prior studies showed that NLR was used to predict the prognosis of patients with AIS after thrombolysis in stroke patients (Brooks et al., 2014 ; Li et al., 2022 ; Maestrini et al., 2015 ). Most studies have collected the NLR value at several time points within 7 days after IVT (generally at admission, 24, 48 h, and 7 days) (Chu et al., 2020 ; Guo et al., 2016 ) and found that NLR level increased after stroke onset and reached the peak at 12–48 h (Li et al., 2022 ; Sadeghi et al., 2022 ; Shi et al., 2018 ; Weng et al., 2021 ). In agreement with these studies, we found that NLR peaked at 24 h after IVT.…”

“…Due to its low cost and easy availability in clinical practice, neutrophil‐to‐lymphocyte ratio (NLR) has been reported to have strong prognostic effects on clinical outcomes of AIS patients without reperfusion treatment, for example, the association of NLR with short‐term mortality, stroke severity on admission, unfavorable functional outcome, and recurrent ischemic stroke (Goyal et al., 2018 ; Sharma et al., 2022 ; Tokgoz et al., 2013 ; Wang et al., 2019 ). In AIS patients treated with IVT, most of these studies focused on the predictive effects of NLR at admission and within 24 h after IVT (Brooks et al., 2014 ; Li et al., 2022 ; Maestrini et al., 2015 ), and only a few studies expanded the time points to 48 h, 3 days, or even 7 days (Guo et al., 2016 ; Weng et al., 2021 ); however, there is a lack of studies to systemically investigate the prognostic roles of NLR at extended time point and their dynamic changes in AIS patients after IVT.…”