Dynamic change of neutrophil to lymphocyte ratio and hemorrhagic transformation after thrombolysis in stroke

Abstract

BackgroundThe neutrophil to lymphocyte ratio (NLR) has been shown to predict short- and long-term outcomes in ischemic stroke patients. We sought to explore the temporal profile of the plasma NLR in stroke patients treated with intravenous thrombolysis (IVT) and its relationship with intracranial bleeding complications after thrombolysis.MethodsA total of 189 ischemic stroke patients were prospectively enrolled. Blood samples for leukocyte, neutrophil, and lymphocyte counts were obtained at admission and at 3–6, 12–18, and 36–48 h after IVT. Head CT was performed on admission and repeated after 36–48 h, and a CT scan was done immediately in case of clinical worsening. Hemorrhagic events were categorized as symptomatic intracranial hemorrhage (sICH) and parenchymal hematomas (PH) according to previously published criteria.ResultsAn increasing trend in the NLR was observed after stroke, and the NLR was higher in patients who developed PH or sICH at 3–6, 12–18, and 36–48 h after IVT (P < 0.01) than in those without PH or sICH. The optimal cutoff value for the serum NLR as an indicator for auxiliary diagnosis of PH and sICH was 10.59 at 12–18 h. Furthermore, the NLR obtained at 12–18-h post-treatment was independently associated with PH (adjusted odds ratio [OR] 1.14) and sICH (adjusted OR 1.14). In addition, patients with a NLR ≥10.59 had an 8.50-fold greater risk for PH (95 % confidence interval [CI] 2.69–26.89) and a 7.93-fold greater risk for sICH (95 % CI 2.25–27.99) than patients with a NLR <10.59.ConclusionsNLR is a dynamic variable, and its variation is associated with HT after thrombolysis in stroke patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12974-016-0680-x) contains supplementary material, which is available to authorized users.

Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke

“…The study by Maestrini et al [17] showed that NLR could predict the occurrence of hemorrhagic transformation for patients with IVT, and it was verified by Guo et al [16] in Chinese population. We believe that the predictive value of NLR for safety outcomes is equally applicable in AIS patients after EVT.…”

“…Therefore, as a readily available biomarker, neutrophil-lymphocyte ratio (NLR) reflected systemic inflammation and predicted the outcomes of stroke [13]. Previous studies [14, 15] have shown that NLR was associated with 3-month functional outcome in stroke patients, and higher NLR or dynamic change of NLR could independently predict symptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis (IVT) [16, 17]. …”

Early increase of neutrophil‐to‐lymphocyte ratio predicts 30‐day mortality in patients with spontaneous intracerebral hemorrhage

“…Increased NLR is also related to increased 90‐day morbidity and mortality and decreased quality of life, and has been shown to be an independent risk for ICH development in diabetic patients . NLR increases with severity of hemorrhagic transformation and with time following cerebral thrombolysis . Given that fact that inflammation occurs through all stages in patients with spontaneous ICH, it is reasonable to speculate that NLR could reflect ICH progression.…”

“…NLR varies with severity of bleeding during hemorrhagic transformation after cerebral thrombolysis and with the duration between ICH onset and blood sampling . The fact that NLR changes with ICH progression raises the question of under what conditions .…”

Neutrophil‐to‐lymphocyte ratio predicts hemorrhagic transformation in ischemic stroke: A meta‐analysis

“…Previous studies have shown that the NLR is independently associated with clinical outcomes and short‐term mortality in patients with AIS (Gokhan et al, ; Tokgoz, Keskin, Kayrak, Seyithanoglu, & Ogmegul, ; Yu et al, ; Zhang et al, ). In addition, it was reported that a higher admission NLR is an independent risk factor for HT and 3‐month functional outcome in patients with AIS both with and without reperfusion therapy (Duan et al, ; Goyal et al, ; Guo et al, ; Maestrini et al, ; Pikija et al, ; Song et al, ). The subject of our study was to comprehensively summarize the value of NLR for predicting HT in patients with AIS by performing a meta‐analysis.…”