The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke

Abstract

Background and purpose To investigate the association of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS). Methods AIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as the National Institutes of Health Stroke Scale (NIHSS) score increase of ≥ 4 within 24 h after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥ 4 or complete recovery within 24 h. Multinomial logistic regression analysis was performed to explore the relationship of NLR, PLR, and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI. Results Among 1060 recruited patients, a total of 193 (18.2%) were diagnosed with END and 398 (37.5%) were diagnosed with ENI. Multinomial logistic model indicated that NLR (odds ratio [OR], 1.385; 95% confidence interval [CI] 1.238–1.551, P = 0.001), PLR (OR, 1.013; 95% CI 1.009–1.016, P = 0.001), and LMR (OR, 0.680; 95% CI 0.560–0.825, P = 0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.713; 95% CI 0.643–0.791, P = 0.001) served as an independent factor for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR, and LMR to discriminate END were 0.763, 0.703, and 0.551, respectively. AUC of NLR, PLR, and LMR to discriminate ENI were 0.695, 0.530, and 0.547, respectively. Conclusions NLR, PLR, and LMR were associated with post-thrombolysis END. NLR and PLR may predict post-thrombolysis END. NLR was related to post-thrombolysis ENI.

Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis

“…Various studies have shown that NLR is closely related to AIS dysfunction, short-term mortality, stroke severity on admission, primary unfavorable functional outcome, recurrent ischemic stroke and post stroke infections, greater risk of symptomatic intracranial hemorrhage, poor 3-month functional outcome, and 3-month mortality in AIS patients undergoing reperfusion treatments, which is consistent with our results (Xue et al, 2017;Kocaturk et al, 2019;Chen et al, 2020;Giede-Jeppe et al, 2020;He et al, 2020;AltinbaŞ et al, 2021;Bi et al, 2021;Ferro et al, 2021;Gong et al, 2021;Hu et al, 2021;Huang et al, 2021;Lin et al, 2021). In a recent study, NLR ≥ 9 was an independent predictor of new in-hospital neurologic complications (Heuschmann et al, 2004).…”

The Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Reperfusion and Prognosis after Endovascular Treatment of Acute Ischemic Stroke

“…Hence, several studies have shown that these inflammatory reactions promote worsening symptoms and poor prognosis after acute ischemic stroke. Determining the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) is a rapid and easy method used to determine this inflammatory response [ 14 , 15 , 16 ]. Novel biomarkers that reflect the baseline inflammatory process in patients with ischemic stroke are widely used in studies to predict the prognosis of several subjects with cerebrovascular disease [ 16 , 17 , 18 , 19 ].…”

Blood-Based Biomarkers: A Forgotten Friend of Hyperacute Ischemic Stroke

“…Neutrophils, Neutrophil to Lymphocyte Ratio (NLR), and Platelet to Lymphocyte Ratio (PLR) NLR and PLR have recently been reported as potential novel biomarkers of the baseline inflammatory process and could serve as outstanding predictors in patients with IS (35,36). Before intravenous thrombolysis treatment, the AUCs of NLR and PLR for predicting post-thrombolysis early neurological deterioration and NLR for predicting post-thrombolysis early neurological improvement were 0.763, 0.703, and 0.695, respectively (37). Additionally, within 4.5 h after symptom onset, serum neutrophil counts and NLR were positively correlated with IS severity, and higher neutrophil counts and NLR were independently associated with worse outcomes and higher mortality rates at month 3 (38).…”