Eosinophil-to-Neutrophil Ratio Predicts Poor Prognosis of Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis

Abstract

Background and Purpose: The eosinophil-to-neutrophil ratio (ENR) was recently reported as a novel inflammatory marker in acute ischemic stroke (AIS). However, few studies reported the predictive value of ENR in AIS patients, especially for those with intravenous thrombolysis.Methods: Two hundred sixty-six AIS patients receiving intravenous thrombolysis were retrospectively recruited in this study and followed up for 3 months and 1 year. The Modified Rankin Scale (mRS) and the time of death were recorded. Poor outcome was defined as mRS 3–6. After excluding patients who were lost to follow-up, the remaining 250 patients were included in the 3-month prognosis analysis and the remaining 223 patients were included in the 1-year prognosis analysis.Results: ENR levels in the patients were lower than those in the healthy controls. The optimal cutoff values for the ability of ENR × 102 to predict 3-month poor outcome were 0.74 with 67.8% sensitivity and 77.3% specificity. Patients with ENR × 102 ≥ 0.74 have a lower baseline National Institutes of Health Stroke Scale (NIHSS) score (median: 7 vs. 11, p < 0.001). After multivariate adjustment, patients with ENR × 102 ≥ 0.74 were more likely to come to a better 3-month outcome (OR = 0.163; 95% CI, 0.076–0.348, p < 0.001). At the 1-year follow-up, the patients with ENR × 102 ≥ 0.74 showed a lower risk of mortality (HR = 0.314; 95% CI, 0.135–0.731; p = 0.007).Conclusions: A lower ENR is independently associated with a 3-month poor outcome and a 3-month and 1-year mortality in AIS patients treated with intravenous thrombolysis.

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

“…Eosinophils play a function in regional immunological and inflammatory reactions, but the function of eosinopenia in AIS remains incompletely elucidated. [12] Strong stress responses and eosinophil infiltration may be the significant mechanisms for eosinophil reduction after stroke. [12,17] According to previous research, stroke induced a transient reduction in the number of circulating eosinophils; lower eosinophil counts were correlated with stroke severity and the poor prognosis of AIS patients.…”

“…[12] Strong stress responses and eosinophil infiltration may be the significant mechanisms for eosinophil reduction after stroke. [12,17] According to previous research, stroke induced a transient reduction in the number of circulating eosinophils; lower eosinophil counts were correlated with stroke severity and the poor prognosis of AIS patients. [12,14,29] Our study also confirmed that the LVO group had reduced eosinophil counts, but eosinophils didn’t correlate with the presence of LVO.…”

“…[10,11] Various leukocyte subtypes and ratios, including eosinopenia, eosinophil-to-neutrophil ratio (ENR), and eosinophil-to-monocyte ratio (EMR), neutrophil-to-lymphocyte ratio (NLR) are associated with higher mortality rates, disability at discharge, and adverse functional outcomes (such as a modified Rankin Scale score > 3, large infarct volume, and high infection rate, among others). [8,[12][13][14][15] Although with only modest discriminatory ability, higher counts of neutrophil and total WBC are related to LVO occurrence. Nevertheless, this study may be subject to selection bias.…”

Determination of elevated eosinophil to lymphocyte ratio, eosinophil to neutrophil ratio, eosinophil to monocyte ratio and its association with severe vitiligo: A retrospective cohort study

“…Higher ELR has also been associated with severe chronic spontaneous urticaria [ 9 ]. In addition, EMR and ENR have both been associated with poor outcomes and mortality in acute ischemic stroke patients and chronic obstructive pulmonary disease patients [ 10 , 11 ]. Though the underlying mechanism is still unknown, it is possible that a relative increase in eosinophils plays a role in not only the pathogenesis of vitiligo, but also in the severity of vitiligo.…”

Peripheral eosinophil trends and clinical outcomes after non-traumatic subarachnoid hemorrhage

“…Previous studies have also shown that early eosinopenia can be an independent predictor of severity, poor outcome, and increased mortality in acute ischemic stroke ( 17 , 22 , 23 ). A variety of ratios of eosinophils to other leukocytes including monocytes and neutrophils have also been studied, with lower eosinophil counts typically correlating with poor outcomes ( 24 – 26 ). Similarly, early eosinopenia after intracerebral hemorrhage (ICH) has been associated with increased mortality ( 16 ).…”