Eosinophil: A New Circulating Biomarker for Risk of Poor Outcome in Stroke Patients Undergoing Mechanical Thrombectomy

Abstract

Objective Acute ischemic stroke (AIS), caused by occlusion of large vessel, is a serious life-threatening disease. This study aimed to comprehensively investigate the association of 14 common and readily available circulating biomarkers with the 90-day modified Rankin Scale (mRS) score in patients undergoing mechanical thrombectomy (MT). Methods This study included patients with anterior circulation large vessel occlusive stroke treated with MT from 05/2017 to 12/2021. Baseline comparisons of poor outcome were performed among enrolled patients. Factors that may be associated with the mRS score were assessed using correlation analysis. Univariate and multivariate logistic regression analyses were used to evaluate the predictive value of circulating biomarkers and poor outcome. Results The mRS score has a strong correlation with neutrophil to lymphocyte ratio (NLR) and eosinophil levels (all r s >0.4 in absolute value and all P<0.001) in addition to a high correlation with National Institute of Health Stroke Scale (NIHSS) score (r s =0.40, P<0.001). There was also a high correlation between NLR and eosinophil (r s =−0.58, P<0.001). In the multivariate regression analysis, only neutrophil (adjusted OR=1.301, 95% CI: 1.155−1.465, P<0.001), eosinophil (adjusted OR<0.001, 95% CI: <0.001−0.016, P<0.001), and NLR (adjusted OR=1.158, 95% CI: 1.082−1.241, P<0.001) were independently associated with poor outcome. Conclusion This study evaluated a series of circulating biomarkers and found that neutrophil, eosinophil, and NLR independently predicted poor outcome after MT in AIS patients. There was a significant negative correlation between eosinophil and NLR levels.

Leukocyte counts and ratios as potential predictors of large vessel occlusion in acute ischemic stroke: A retrospective cohort study

“…Studies have shown that AIS causes a sudden rise in the circulation of neutrophils and a decline in circulating lymphocytes. [30,31] Thus, NLR is a reliable indicator of inflammation in AIS. In previous research, [32] high NLR values were related to adverse outcomes, and NLR has been identified as a mortality indicator for patients with severe brain trauma injuries.…”

Risk factors for stroke outcomes in adults: Stroke in China

“…Many studies have found the influence of factors such as age, gender, smoking, and alcohol consumption on stroke prognosis. A thorough examination of 39 research studies, encompassing a collective participation of 359,783 individuals, unveiled a notable disparity in the prevalence of diabetes between ischemic strokes (IS) (33%, 95% CI ~ [28][29][30][31][32][33][34][35][36][37][38] and hemorrhagic strokes (26%, 95% CI ~ [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Furthermore, the analysis established a clear association between both acute hyperglycemia and diabetes and adverse post-stroke outcomes, whether ischemic or hemorrhagic.…”

“…Neutrophils, eosinophils, and neutrophil-to-lymphocyte ratio were independent factors for poor prognosis after mechanical thrombectomy in AIS patients. [ 30 ] High platelet count and high-sensitivity C-reactive protein (HS-CRP) were significantly associated with adverse clinical outcomes. [ 31 ] High-density lipoprotein (HDL) was associated with mild cognitive impairment and dementia.…”

Symptomatic intracranial hemorrhage mediates the association between eosinophils and 90-day outcomes after mechanical thrombectomy for acute ischemic stroke

“…Reduced eosinophil levels are associated with poor prognosis after mechanical thrombectomy in patients with acute ischemic stroke (AIS), but the underlying mechanism of this association is unclear [ 1 , 2 ]. In contrast, in our previous study, lower eosinophil levels were associated with a higher incidence of stroke-associated pneumonia (SAP); in addition, SAP was found to play an important mediating role in the association between eosinophilia and poor prognosis.…”