Neutrophil–lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis

Abstract

There is an ongoing need for accurate prognostic biomarkers in the milieu of acute ischemic stroke (AIS) receiving reperfusion therapy. Neutrophil–lymphocyte ratio (NLR) has been implicated in emergency medicine and acute stroke setting as an important biomarker in the prognosis of patients. However, there are ongoing questions around its accuracy and translation into clinical practice given suboptimal sensitivity and specificity results, as well as varying thresholds and lack of clarity around which NLR time points are most clinically indicative. This article provides a comprehensive overview of the role of NLR in AIS patients receiving reperfusion therapy and perspectives on areas of future research. NLR may be an important biomarker in risk stratifying patients in AIS to identify and select those who are more likely to benefit from reperfusion therapy. Appropriate clinical decision‐making tools and models are required to harness the predictive value of NLR, which could be useful in identifying and monitoring high‐risk patients to guide early treatment and achieve improved outcomes. Our understanding of the role of NLR in the immunopathogenesis of AIS is also suboptimal, which hinders the ability to translate this into clinical practice.

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

“…Inflammatory cells play a crucial role in collaterogenesis, due to their ability to produce metalloproteinases and growth factors [ 5 , 41 , 42 ]. They are involved also in the formation of atherosclerotic plaques, thus highlighting their role in LAA strokes [ 43 ].…”

“…A higher neutrophil count one day after hospital admission was associated with sICH while a higher NLR was associated with parenchymal haemorrhage and sICH [ 33 ]. We postulate that the progression to poor outcomes despite good collateral status and successful reperfusion, e.g., in AIS patients with LAA, may be explained by other factors such as NLR [ 42 ] and severity of leukoaraiosis [ 44 , 45 ].…”

Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review

“… 9 Additionally, other factors, including patient-associated socioeconomic variables and health system parameters, also impact access to acute care services and postreperfusion therapy outcomes in AIS. 29 - 34 …”

Prognostic Role of Chronic Rhinosinusitis in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

“…The relevant literature reports multiple examples of clinical, biological, biochemical, and radiological factors with potential relevance to the prognosis for ischaemic stroke patients treated with mechanical thrombectomy [22,23]. The factors associated with a poorer prognosis following thrombectomy include: age, comorbitidies (HA, DM), previous stroke, stroke severity, the Alberta Stroke Program Early CT Score (ASPECTS), ischemic core volume, mismatch of ischemic core and hypoperfusion volume, white matter lesions, the location of the occlusion, collateral flow status and neutrophil lymphocyte ratio [5][6][7][8]24,25].…”