Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy

Feng, Yao; Bai, Xuesong; Li, Wei; Cao, Wenbo; Xu, Xin; Fan, Yujing; Fu, Zhiyong; Tian, Qiuyue; Guo, Xiaofan; Wang, Tao; Sha, Arman; Chen, Yanfei; Gao, Peng; Wang, Yabing; Chen, Jian; Ma, Yan; Chen, Fei; Dmytriw, Adam A.; Regenhardt, Robert W; Lu, Jie; Ma, Qingfeng; Yang, Bin

doi:10.3389/fimmu.2022.963111

Cited by 16 publications

(35 citation statements)

References 36 publications

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“…The inflammatory mediators, cytokines, adhesion molecules, and chemokines released by immune inflammatory cells exacerbate tissue damage. According to previous studies, IR can be activated immediately after stroke event has occurred and is associated with poor prognosis ( 22 – 24 ). The mentioned mechanisms explain why the biomarkers now being researched are based on numerous inflammatory variables linked to stroke.…”

Section: Discussionmentioning

confidence: 91%

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Systemic inflammation response index predicts 3-month outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis

et al. 2023

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IntroductionA crucial aspect of stroke progression is the inflammatory response. As novel inflammatory and prognostic markers, the systemic immune inflammation index (SII) and the systemic inflammation response index (SIRI) have recently been studied. The objective of our study was to evaluate the prognostic value of SII and SIRI in mild acute ischemic stroke (AIS) patients following intravenous thrombolysis (IVT).MethodsOur study screened the clinical data of patients with mild AIS admitted to the Minhang Hospital of Fudan University for retrospective analysis. The SIRI and SII were examined by the emergency laboratory before IVT. Functional outcome was evaluated 3 months after the onset of stroke using the modified Rankin Scale (mRS). mRS ≥ 2 was defined as an unfavorable outcome. The relationship between SIRI and SII and the 3-month prognosis was determined using both univariate and multivariate analysis. Receiver operating characteristic curve was performed to evaluate the predictive value of SIRI for AIS prognosis.ResultsA total of 240 patients were included in this study. Both SIRI and SII were higher in the unfavorable outcome group than in the favorable outcome group [1.28 (0.70–1.88) vs. 0.79 (0.51–1.08), P < 0.001 and 531.93 (377.55–797.12) vs. 397.23 (263.32–577.65), P < 0.001]. Multivariate logistic regression analyses showed that SIRI was significantly associated with 3-month unfavorable outcome of mild AIS patients [odds ratio (OR) = 2.938, 95% confidence interval (CI) = 1.805–4.782, P < 0.001], conversely, SII had no prognostic value. When SIRI combined with the established clinical factors, the area under the curve (AUC) showed a significant improvement (0.773 vs. 0.683, P for comparison = 0.0017).ConclusionsHigher SIRI could be valuable in predicting poor clinical outcomes for patients with mild AIS following IVT.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 94%

Systemic inflammation response index predicts 3-month outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis

et al. 2023

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“…Several studies have shown that NLR as a dynamic variable is associated with HT ( 15 , 16 ), sICH ( 15 , 19 , 40 , 42 , 71 , 75 ), 3-month PFO ( 16 , 19 , 38 , 40 , 42 , 51 , 58 , 63 , 71 , 75 , 76 ), and death ( 19 , 38 , 58 , 63 , 71 ) in patients with AIS after IVT or EVT. These studies also showed that the post-treatment NLR has a more strong predictive ability for the poor prognosis of patients with AIS after reperfusion therapy than admission.…”

Section: Discussionmentioning

confidence: 99%

Prognostic role of dynamic neutrophil-to-lymphocyte ratio in acute ischemic stroke after reperfusion therapy: A meta-analysis

Wu¹,

Fang²,

Sun³

et al. 2023

Front. Neurol.

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BackgroundThe prognostic role of the neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, in acute ischemic stroke (AIS) after reperfusion therapy remains controversial. Therefore, this meta-analysis sought to assess the correlation between the dynamic NLR and the clinical outcomes of patients with AIS after reperfusion therapy.MethodsPubMed, Web of Science, and Embase databases were searched to identify relevant literature from their inception to 27 October 2022. The clinical outcomes of interest included poor functional outcome (PFO) at 3 months, symptomatic intracerebral hemorrhage (sICH), and 3-month mortality. The NLR on admission (pre-treatment) and post-treatment was collected. The PFO was defined as a modified Rankin scale (mRS) of >2.ResultsA total of 17,232 patients in 52 studies were included in the meta-analysis. The admission NLR was higher in the 3-month PFO (standardized mean difference [SMD] = 0.46, 95% confidence interval [CI] = 0.35–0.57), sICH (SMD = 0.57, 95% CI = 0.30–0.85), and mortality at 3 months (SMD = 0.60, 95% CI = 0.34–0.87). An elevated admission NLR was associated with an increased risk of 3-month PFO (odds ratio [OR] = 1.13, 95% CI = 1.09–1.17), sICH (OR = 1.11, 95% CI = 1.06–1.16), and mortality at 3 months (OR = 1.13, 95% CI = 1.07–1.20). The post-treatment NLR was significantly higher in the 3-month PFO (SMD = 0.80, 95% CI = 0.62–0.99), sICH (SMD = 1.54, 95% CI = 0.97–2.10), and mortality at 3 months (SMD = 1.00, 95% CI = 0.31–1.69). An elevated post-treatment NLR was significantly associated with an increased risk of 3-month PFO (OR = 1.25, 95% CI = 1.16–1.35), sICH (OR = 1.14, 95% CI = 1.01–1.29), and mortality at 3 months (OR = 1.28, 95% CI = 1.09–1.50).ConclusionThe admission and post-treatment NLR can be used as cost-effective and easily available biomarkers to predict the 3-month PFO, sICH, and mortality at 3 months in patients with AIS treated with reperfusion therapy. The post-treatment NLR provides better predictive power than the admission NLR.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022366394.

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“…Another analysis demonstrated that an early increase in body temperature within 24 hours after EVT was associated with sICH and worse long term outcomes [ 34 ]. Neutrophil-lymphocyte ratio may be yet another novel predictor of outcome after EVT that requires further study [ 35 ]. Other imaging features, such as percent insular ribbon infarction, may also play a role in understanding infarct growth and long term outcomes [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Symmetric collateral pattern on CTA predicts favorable outcomes after endovascular thrombectomy for large vessel occlusion stroke

Regenhardt

Lev

et al. 2023

PLoS ONE

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Endovascular thrombectomy (EVT) has revolutionized large vessel occlusion (LVO) stroke management, but often requires advanced imaging. The collateral pattern on CT angiograms may be an alternative because a symmetric collateral pattern correlates with a slowly growing, small ischemic core. We tested the hypothesis that such patients will have favorable outcomes after EVT. Consecutive patients (n = 74) with anterior LVOs who underwent EVT were retrospectively analyzed. Inclusion criteria were available CTA and 90-day modified Rankin Scale (mRS). CTA collateral patterns were symmetric in 36%, malignant in 24%, or other in 39%. Median NIHSS was 11 for symmetric, 18 for malignant, and 19 for other (p = 0.02). Ninety-day mRS ≤2, indicating independent living, was achieved in 67% of symmetric, 17% of malignant, and 38% of other patterns (p = 0.003). A symmetric collateral pattern was a significant determinant of 90-day mRS ≤2 (aOR = 6.62, 95%CI = 2.24,19.53; p = 0.001) in a multivariable model that included age, NIHSS, baseline mRS, thrombolysis, LVO location, and successful reperfusion. We conclude that a symmetric collateral pattern predicts favorable outcomes after EVT for LVO stroke. Because the pattern also marks slow ischemic core growth, patients with symmetric collaterals may be suitable for transfer for thrombectomy. A malignant collateral pattern is associated with poor clinical outcomes.

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Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy

Cited by 16 publications

References 36 publications

Systemic inflammation response index predicts 3-month outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis

Systemic inflammation response index predicts 3-month outcome in patients with mild acute ischemic stroke receiving intravenous thrombolysis

Prognostic role of dynamic neutrophil-to-lymphocyte ratio in acute ischemic stroke after reperfusion therapy: A meta-analysis

Symmetric collateral pattern on CTA predicts favorable outcomes after endovascular thrombectomy for large vessel occlusion stroke

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