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

Abstract

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.

The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting

“…This cut-off was supported by recent studies demonstrating higher mortality and infectious complications in stroke patients with a ≥ 5 NLR 9 , 15 – 17 . Altogether, this data consistently suggests that NLR ≥ 5 may be considered a proper marker of SII, associated with post-stroke mortality, short-term global outcome (modified Rankin Scale), intracerebral haemorrhage (ICH), rate of infectious complications, and post-stroke depression 10 – 14 . The majority of available evidence on SII is derived from acute phase studies.…”

“…Previous studies found higher NLR values in the acute phase of ischemic or haemorrhagic stroke 6 – 9 . The clinical role of NLR in patients with acute stroke admitted to the intensive care setting has been detailed in several recent systematic reviews and meta-analyses 10 – 14 . Although a definite consensus is lacking, the presence of SII seems consistent in patients with a NLR ≥ 5 9 , 15 – 17 .…”

Systemic-inflammatory indices and clinical outcomes in patients with anterior circulation acute ischemic stroke undergoing successful endovascular thrombectomy

“…The thromboinflammatory response has been observed in all phases of AIS [ [13] , [14] , [15] ]. Importantly, this process can also occur in patients who initially achieve successful mechanical recanalization, potentially leading to secondary tissue damage and exacerbating stroke outcomes [ 14 , 36 , 37 ]. Previous study has also demonstrated that patients undergoing EVT are more likely to experience significant dynamic changes in a variety of immune indices compared to those receiving IVT alone [ 29 ].…”

“…Our study demonstrated that day 1 SII and AISI were independent predictors of 90-day functional outcome, while day 1 SII and SIRI served as independent predictors of sICH occurrence. These markers are derived from the well-established NLR, may partially explain their predictive capacities [ 37 ]. Given that these markers offer a comprehensive reflection of the host's inflammatory, immune, and thrombotic status, and have shown superior predictive ability compared to single-cell counts and variables based on two cell subtypes [ 21 ].…”

“…Other possible reasons include the VWI caused by interventional therapy [ [8] , [9] , [10] ], the development and progression of thromboinflammation, and the subsequent reperfusion injury [ 14 , 36 ], which could not be reflected by the admission indices. Wu et al [ 37 ] conducted a meta-analysis involving 52 studies, which found that the post-treatment NLR has a stronger predictive ability for the poor prognosis of AIS patients after reperfusion therapy compared to admission NLR. Further confirmation of our conclusion is needed.…”