Association of Neutrophil-to-Lymphocyte Ratio and Lymphocyte-to-Monocyte Ratio with Treatment Modalities of Acute Ischaemic Stroke: A Pilot Study

Abstract

Background and Objectives: Ischaemic stroke (IS) is the leading cause of death and disability worldwide. All stages of cerebral ischaemia, but especially acute phase, are associated with inflammatory response. Recent studies showed that neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) may be used to assess inflammation in IS. To test whether there is a relationship between these parameters and type of stroke treatment, we analysed NLR and LMR in IS patients treated with three different modalities. Materials and Methods: The study included 58 adults with acute IS. A total of 28 patients received intravenous thrombolysis. In another 10 patients, the thrombolytic therapy was followed by thrombectomy and 20 patients did not undergo causal treatment. Blood samples were obtained within 24 h of the stroke diagnosis to calculate NLR and LMR. Next, NLR and LMR of the study subgroups were compared. Results: Our study revealed that NLR was significantly higher in patients treated with thrombectomy following thrombolysis, compared to no causal treatment. Statistical analysis demonstrated that patients with high National Institutes of Health Stroke Scale (NIHSS) scores presented higher NLR than in those with low NIHSS scores. Additionally, patients with high-sensitivity C-reactive protein (hs-CRP) ≥ 3 mg/L presented with significantly higher NLR and significantly lower LMR than the group of patients with lower hs-CRP (<3 mg/L). Conclusions: The main finding of this pilot study was that NLR in IS patients treated using thrombectomy following thrombolysis was markedly higher than that in other treatment groups, which was associated with increased severity of the disease in these patients. Therefore, patients with higher NLR may be expected to have more severe stroke. The link between stroke severity and NLR deserves further study.

Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit—A Prospective Cohort Study

“…It is still unclear how to identify patients who will develop HT and several causes have been proposed, such as genetics [38], baseline ischemic core [39], age and stroke severity [40], blood pressure [41,42], IVT [43] and inflammation [44].…”

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

“…Interestingly, similar biomarkers predict outcomes in stroke ( 33 – 39 ). In particular, it is known that patients who show elevated NLR, ferritin, CRP, D-dimer and fibrinogen have a higher risk for stroke and equate to potentially poorer clinical outcomes ( 33 – 39 ).…”

“…Furthermore, elevated D-dimer and hyperfibrinogenemia, which are both biomarkers of inflammation and hypercoagulable state, have also been shown to predict the severity of the said infection (31,32). Interestingly, similar biomarkers predict outcomes in stroke (33)(34)(35)(36)(37)(38)(39). In particular, it is known that patients who show elevated NLR, ferritin, CRP, D-dimer and fibrinogen have a higher risk for stroke and equate to potentially poorer clinical outcomes (33)(34)(35)(36)(37)(38)(39).…”

Multiple Thrombectomies in the Same Patient within One Month: Case Report of a Patient with Trousseau Syndrome and Acute Ischemic Stroke

“…The NETs are proposed to serve as a scaffolding for the collection of red blood cells, platelets, fibrinogen, and platelet adhesion molecules along with activating both intrinsic and extrinsic coagulation pathways leading to downstream thrombosis. This has led to further research to evaluate NET specific biomarkers and their usefulness in determining patients’ risk for pro-coagulable state [ 6 , 7 , 8 , 9 ].…”