Association of lower leukocyte count before thrombolysis with early neurological improvement in acute ischemic stroke patients

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: Discussionsupporting

confidence: 93%

Section: De Nition Of Post-thrombolysis Early Neurological Deterioratmentioning

confidence: 99%

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

“…Several studies have explored the role of advanced neuroimaging‐based biomarkers in AIS, 6 however, given the limited availability of advanced neuroimaging, simple, routinely collected blood‐based biomarkers are of immense clinical and translational significance 6 . One such biomarker harnessing the role of the immune system in emergent clinical settings is the neutrophil–lymphocyte ratio (NLR), which has demonstrated utility in emergency medicine 7 and acute stroke settings, 2,8‐29 with both neutrophils and lymphocytes having been implicated in AIS immunopathogenesis 3‐5,30 . However, its prognostic role in AIS patients receiving reperfusion therapy is not yet clearly delineated 2,8,9,11‐17,19‐29,31,32 …”

Section: Introductionmentioning

confidence: 99%

“…One such biomarker harnessing the role of the immune system in emergent clinical settings is the neutrophil–lymphocyte ratio (NLR), which has demonstrated utility in emergency medicine 7 and acute stroke settings, 2,8‐29 with both neutrophils and lymphocytes having been implicated in AIS immunopathogenesis 3‐5,30 . However, its prognostic role in AIS patients receiving reperfusion therapy is not yet clearly delineated 2,8,9,11‐17,19‐29,31,32 …”

Section: Introductionmentioning

confidence: 99%

Neutrophil–lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis

2021

There is an ongoing need for accurate prognostic biomarkers in the milieu of acute ischemic stroke (AIS) receiving reperfusion therapy. Neutrophil–lymphocyte ratio (NLR) has been implicated in emergency medicine and acute stroke setting as an important biomarker in the prognosis of patients. However, there are ongoing questions around its accuracy and translation into clinical practice given suboptimal sensitivity and specificity results, as well as varying thresholds and lack of clarity around which NLR time points are most clinically indicative. This article provides a comprehensive overview of the role of NLR in AIS patients receiving reperfusion therapy and perspectives on areas of future research. NLR may be an important biomarker in risk stratifying patients in AIS to identify and select those who are more likely to benefit from reperfusion therapy. Appropriate clinical decision‐making tools and models are required to harness the predictive value of NLR, which could be useful in identifying and monitoring high‐risk patients to guide early treatment and achieve improved outcomes. Our understanding of the role of NLR in the immunopathogenesis of AIS is also suboptimal, which hinders the ability to translate this into clinical practice.

“…In addition, it is reported that neutrophils are related with the blood brain barrier breakdown and their infiltration seems to be associated with higher inflammation and have a role in cerebral ischemia [78], and higher neutrophil counts before thrombolysis have been associated with worse 3-month outcomes [79]. However, there are few studies analyzing the relation of leukocytes (including neutrophils and lymphocytes) with acute stroke outcome [80-82]. In Nardi et al [80], authors aimed to establish whether admission leukocyte count affects early stroke outcome.…”

Section: Variables Associated With Acute Outcomementioning

confidence: 99%

Clinical Variables and Genetic Risk Factors Associated with the Acute Outcome of Ischemic Stroke: A Systematic Review

Torres-Águila¹,

Carrera

Muiño³

et al. 2019

J Stroke

Stroke is a complex disease and one of the main causes of morbidity and mortality among the adult population. A huge variety of factors is known to influence patient outcome, including demographic variables, comorbidities or genetics. In this review, we expound what is known about the influence of clinical variables and related genetic risk factors on ischemic stroke outcome, focusing on acute and subacute outcome (within 24 to 48 hours after stroke and until day 10, respectively), as they are the first indicators of stroke damage. We searched the PubMed data base for articles that investigated the interaction between clinical variables or genetic factors and acute or subacute stroke outcome. A total of 61 studies were finally included in this review. Regarding the data collected, the variables consistently associated with acute stroke outcome are: glucose levels, blood pressure, presence of atrial fibrillation, prior statin treatment, stroke severity, type of acute treatment performed, severe neurological complications, leukocyte levels, and genetic risk factors. Further research and international efforts are required in this field, which should include genome-wide association studies.