Neutrophil‐to‐lymphocyte ratio, hyperglycemia, and outcomes in ischemic stroke patients treated with intravenous thrombolysis

Cheng, Yani; Ying, Anna; Lin, Yanyan; Yu, Junru; Luo, Ji; Zeng, Yifan; Lin, Yuanshao

doi:10.1002/brb3.1741

Cited by 23 publications

(31 citation statements)

References 32 publications

(47 reference statements)

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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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“…Ten studies reported the association between NLR and 3-month poor functional outcome (mRS≥3) after IVT [11,[19][20][21][22][23][24][25][26]28].…”

Section: Functional Outcomementioning

confidence: 99%

“…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%

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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“…9 Several studies have demonstrated a detrimental effect of hyperglycaemia on poor functional outcome and mortality in patients who had a stroke treated with r-tPA. 10–12 Klingbeil et al suggested that hyperglycaemia independently predicted HT after stroke. 9 Zonneveld et al reported that admission hyperglycaemia was associated with poststroke infections in patients who are non-diabetic and had a AIS.…”

Section: Introductionmentioning

confidence: 99%

Impact of hyperglycaemia on complications in patients who had a stroke after thrombolysis

Cheng

Luo

Lin

et al. 2020

Postgraduate Medical Journal

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BackgroundWe sought to investigate whether admission hyperglycaemia is associated with complications in patients who had an acute ischaemic stroke (AIS) treated with intravenous recombinant tissue plasminogen activator and, if so, whether complications during hospitalisation modify the effect of hyperglycaemia on 3-month poor outcome after thrombolysis.MethodsPatients who were diagnosed with AIS after thrombolysis between July 2016 and January 2019 were enrolled in this study. Five prespecified complications, including infections, brain oedema, deep vein thrombosis (DVT), haemorrhagic transformation (HT) and gastrointestinal bleeding, were recorded during hospitalisation.ResultsOf 388 patients, 143 (36.86%) presented with hyperglycaemia. Patients with hyperglycaemia were more likely to experience one or more complications than patients without hyperglycaemia. After adjustment for potential confounders, hyperglycaemia was associated with brain oedema (OR 2.39; 95% CI 1.08 to 5.30), HT (OR 2.16, 95% CI 1.06 to 4.41), symptomatic intracerebral haemorrhage (sICH) (OR 7.32, 95% CI 2.35 to 22.80) and gastrointestinal bleeding (OR 3.62; 95% CI 1.93 to 6.80), but was not linked to infections (OR 1.48, 95% CI 0.76 to 2.9) and DVT (OR 0.60, 95% CI 0.23 to 1.5). Additional adjustment for the complications in the clinical outcome analysis, done to assess these complications as an intermediate in the pathway from admission hyperglycaemia to clinical outcome, did not substantially change the model (all p for interaction >0.05).ConclusionHyperglycaemia is an independent predictor of complications following stroke after thrombolysis, especially for brain oedema, gastrointestinal bleeding, HT and sICH. Complications during hospitalisation did not modify the effect of hyperglycaemia on the poor outcome at 3 months in ischaemic stroke.

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Neutrophil‐to‐lymphocyte ratio, hyperglycemia, and outcomes in ischemic stroke patients treated with intravenous thrombolysis

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 23 publications

References 32 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

Impact of hyperglycaemia on complications in patients who had a stroke after thrombolysis

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