Neutrophil–lymphocyte ratio predicts post‐thrombolysis early neurological deterioration in acute ischemic stroke patients

Abstract

Background and purpose Intravenous thrombolysis (IVT) has become the standard treatment for acute ischemic stroke within 4.5 hr after symptoms onset. However, a fraction of patients would develop early neurological deterioration (END) after IVT. The aim of our study was to explore the utility of neutrophil–lymphocyte ratio (NLR) in predicting END. Methods From October 2016 to March 2018, 342 consecutive patients with thrombolytic therapy were prospectively enrolled in this study. Blood cell counts were sampled in stroke emergency room before IVT. END was defined as a National Institutes of Health Stroke Scale score increase of ≥4 points within 24 hr after IVT. Multiple regression analysis was used to investigate the potential risk factors of END. We also performed receiver operating characteristic curve analysis and nomogram analysis to assess the overall discriminative ability of the NLR in predicting END. Results Of the 342 patients, 86 (25.1%) participants were identified with END. Univariate logistic regression analysis demonstrated that patients with NLR in the third tertile, compared with the first tertile, were more likely to have END (odds ratio, 9.783; 95% confidence interval [CI], 4.847–19.764; p = .001). The association remained significant even after controlled for potential confounders. Also, a cutoff value of 4.43 for NLR was detected in predicting post‐thrombolysis END with a sensitivity of 70.9% and a specificity of 79.3% (area under curve, 0.779; 95% CI, 0.731–0.822). Furthermore, our established nomogram indicated that higher NLR was an indicator of post‐thrombolysis END (c‐index was 0.789, p < .001). Conclusions This study showed that elevated level of NLR may predict post‐thrombolysis END in ischemic stroke patients.

The association between high-sensitivity C-reactive protein at admission and progressive motor deficits in patients with penetrating artery infarctions

“…Several inflammatory biomarkers was reported to be correlated with neurological deterioration in patients with acute ischemic stroke, such as lipoprotein-associated phospholipase A2, [16]. neutrophil–lymphocyte ratio [17] and so on. Previous studies have revealed that high-sensitivity C-reactive protein (hs-CRP) may act as an inflammatory factor that responds to ischemic stroke [18, 19].…”

The Association of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio With Post-Thrombolysis Early Neurological Outcomes in Patients With Acute Ischemic Stroke

“…Lymphocyte counts have been considered to have neuroprotective effect and contribute to neurological function improvement [36]. Both peripheral monocytes and neutrophils could perform as the source of matrix metalloproteinase-9, which would lead to HT and symptomatic deterioration [7,37,38]. Furthermore, it is reported that neutrophils can induce free oxygen radicals and cause brain injury [39].…”

“…In case of disagreement about the NIHSS score evaluation, a third neurologist in this center was invited for a nal decision. Post-thrombolysis END was de ned as an increase in the NIHSS score by ≥ 4 points in the total score within 24 hours after thrombolysis [7,24,25].Meanwhile, post-thrombolysis ENI was de ned as a decrease in the NIHSS score by ≥ 4 points in the total score or a complete resolution of neurological de cits within 24 hours after thrombolysis [26][27][28].…”

“…It has been reported that rapid recovery, which is described as early neurological improvement (ENI), can be observed in a signi cant proportion of AIS patients within the rst 24 hours after intravenous thrombolysis [3,4]. However, there are still several patients whose symptoms would worsen and neurological de cits may aggravate within 24 hours after intravenous thrombolysis, named as early neurological deterioration (END) [6][7][8]. Previous researches indicate that post-thrombolysis early neurological outcomes, including post-thrombolysis END as well as post-thrombolysis ENI, are relevant to the prognosis of patients treated with intravenous thrombolysis [9,10].…”

Hypersensitive C-Reactive Protein-Albumin Ratio Predicts Symptomatic Intracranial Hemorrhage After Endovascular Therapy in Acute Ischemic Stroke Patients

“…The mechanisms underlying the association between HAR and sICH after endovascular treatment are not total clear, and further studies are warranted. In term of previous researches, in ammation plays an important role in the pathophysiological mechanism of ischemic stroke [30][31][32][33] . Oxidative stress and in ammatory activity could lead to blood brain barrier disruption, which may be linked to hemorrhagic transformation after endovascular treatment [34] .…”