Dynamic increase in neutrophil levels predicts parenchymal hemorrhage and function outcome of ischemic stroke with r-tPA thrombolysis

Ying, Anna; Cheng, Yani; Lin, Yanyan; Yu, Junru; Wu, Xingwang; Lin, Yuanshao

doi:10.1007/s10072-020-04324-6

Cited by 22 publications

(22 citation statements)

References 37 publications

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“…Many studies have found that baseline NLR levels are higher in some AIS patients, with the increase of neutrophils and the decrease of lymphocytes, higher NLR indicated the imbalanced interaction between central and peripheral inflammation after AIS [36,37]. Many studies shown that higher NLR on admission increased the risk of poor prognosis in AIS patients [16][17][18][19][20], but its diagnostic value for predicting infections after AIS has not been extensively investigated. In this study, we aimed to investigate the association between increased NLR and PSI in patients with AIS, and we found that a higher NLR was associated with increased risk of PSI in patients with AIS.…”

Section: Discussionmentioning

confidence: 99%

“…Higher NLR may be an independent predictor for poor outcome after AIS [15,16]. Recent studies had shown that even in AIS patients with thrombolytic or thrombectomy, high NLR increased risks of early neurological deterioration, parenchymal hemorrhage, 3-month poor outcome, and mortality, especially in patients with diabetes [17][18][19][20]. A retrospective study also shown that NLR on admission was associated with increased risks of 30-day mortality and 90-day poor outcome in patients with critically ill stroke [21].…”

Section: Introductionmentioning

confidence: 99%

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Increased neutrophil-to-lymphocyte ratio predicts the development of post-stroke infections in patients with acute ischemic stroke

Wang

et al. 2020

BMC Neurol

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Background: Infections could increase the risk of poor outcome in patients with acute ischemic stroke (AIS). The peripheral neutrophil-to-lymphocyte ratio (NLR) is an important indicator of inflammation. The purpose of our study was to investigate the association increased NLR with post stroke infections (PSI) in AIS. Methods: In this study, we included 606 consecutive patients with AIS within 24 h. The NLR was calculated by dividing absolute neutrophil counts by absolute lymphocyte counts. Receiver operating characteristic (ROC) curve was performed to identify the optimal cut point of NLR for PSI. The relationship between NLR and PSI was analyzed by multivariable analysis. Results: We assessed 606 consecutive patients with AIS. ROC curve analysis showed that the optimal cut point of NLR for PSI was NLR ≥ 5.79. Compared with no PSI, patients with PSI have higher NLR, older age, higher NIHSS, higher PCT, higher percentage of nasogastric tube feeding and indwelling urinary catheter (P < 0.05). Multivariable analysis showed that NLR ≥ 5.79 [adjusted odds ratio (aOR),4.52; 95% confidence interval (CI),3.02-6.76; P < 0.001], older age (aOR,1.03; 95% CI, 1.00-1.05; P = 0.009), higher admission NIHSS (aOR,1.13; 95%CI, 1.07-1.18; P < 0.001), indwelling urinary catheter (aOR1.83; 95%CI, 1.08-3.10; P = 0.026], and nasogastric tube feeding (aOR2.52; 95%CI, 1.38-4.59; P = 0.003) were associated with increased risk of PSI. Conclusions: Higher NLR can predict PSI in AIS patients. The NLR may help to select high-risk patients to start intervention in time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increased neutrophil-to-lymphocyte ratio predicts the development of post-stroke infections in patients with acute ischemic stroke

Wang

et al. 2020

BMC Neurol

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“…Read the full text of the remaining 37 articles, excluding 5 abstracts, 3 reviews and 17 irrelevant results. Finally, 12 literatures were included in this meta-analysis [11,12,[19][20][21][22][23][24][25][26][27][28].…”

Section: Study Inclusionmentioning

confidence: 99%

“…All 12 studies used standardized intravenous thrombolytic therapy for AIS patients: rt-PA (0.9 mg/kg body weight, maximum 90mg) was injected intravenously within 4.5 h after the onset of ischemic stroke, with 10% of the total dose as a bolus and the rest by a 60minute infusion. Blood samples were collected on admission (n=5) [19,21,23,27,28] and within 24 hours after IVT (n=3) [12,24,26], 4 studies were collected at both two times [11,20,22,25]. HT (including symptomatic intracerebral hemorrhage and parenchymal hemorrhage), mRS at 3 months, mortality were reported in 6, 10, and 4 articles.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Previous meta-analyses have shown that baseline NLR was associated with HT and 3-month poor functional outcome after ischemic stroke [9,10]. In addition, recently studies have shown that NLR was a dynamic variable, and post-IVT NLR can better predict HT and poor functional outcome than admission NLR [11,12]. However, the predictive value of NLR in AIS patients receiving IVT remained controversial.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Value of Neutrophil To Lymphocyte Ratio In Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis: A Meta-Analysis

Wang

Zhang

et al. 2021

Preprint

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Background: The neutrophil to lymphocyte ratio (NLR) has been shown to be an important independent inflammatory indicator in stroke. The relationship between NLR and poor prognostics in acute ischemic stroke (AIS) patients who received intravenous thrombolysis (IVT) still unclear. The purpose of this meta-analysis was to evaluate the association between NLR and poor prognosis after IVT. Furthermore, we aim to concluded whether admission NLR or post-IVT NLR play a role in AIS.Methods: Pubmed, Embase, Wed of Science and China National Knowledge Infrastructure were searched for relevant articles until October 7, 2020. Cohort and case-control studies were included if related to NLR in AIS patients treated with IVT. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were pooled to estimate the relationship between NLR and poor prognosis after IVT. A random effects model was used to calculate the pooled data.Results: Twelve studies, including 3641 patients met the predefined inclusion criteria. Higher NLR levels were associated with an increased risk of hemorrhagic transformation (HT) (OR=1.33,95%CI=1.14-1.56, P<0.001) and 3-month poor functional outcome (OR=1.64,95%CI=1.38-1.94, P<0.001) in AIS patients receiving IVT. Subgroup analysis of HT suggested that admission NLR levels rather than post-IVT NLR levels was associated with higher risk of HT (OR=1.33,95%CI=1.01-1.75, P=0.039). But There had no statistically significant difference between higher NLR levels and 3-month mortality (OR=1.14, 95%CI=0.97-1.35, P=0.120).Conclusions: High NLR can predict HT and 3-month poor functional outcome in AIS patients received IVT. Admission NLR rather than post-IVT NLR was independent risk factor of increased risk of HT.

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Prediction of acute neurovascular syndromes with prehospital clinical features witnessed by bystanders

et al. 2020

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Dynamic increase in neutrophil levels predicts parenchymal hemorrhage and function outcome of ischemic stroke with r-tPA thrombolysis

Cited by 22 publications

References 37 publications

Increased neutrophil-to-lymphocyte ratio predicts the development of post-stroke infections in patients with acute ischemic stroke

Increased neutrophil-to-lymphocyte ratio predicts the development of post-stroke infections in patients with acute ischemic stroke

Prognostic Value of Neutrophil To Lymphocyte Ratio In Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis: A Meta-Analysis

Prediction of acute neurovascular syndromes with prehospital clinical features witnessed by bystanders

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