Values of Lymphocyte-Related Ratios in Predicting the Clinical Outcome of Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis Based on Different Etiologies

Abstract

Background Previous studies confirmed that neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR) were related to the clinical outcomes of acute ischemic stroke (AIS). This study aimed to explore predictive values of these ratios on the clinical outcomes of AIS patients receiving intravenous thrombolysis based on TOAST (Trail of Org 10172 in Acute Stroke Treatment) classification. Methods Patients admitted to department of Neurology with AIS were included. NLR, LMR and PLR were obtained before thrombolysis. Unfavorable functional outcome was defined as a modified Rankin score (mRS) of 3–6 at 90 days after onset. The Receiver Operating Characteristic (ROC) curves were used to explore the predictive values of lymphocyte-related ratios for clinical outcomes after receiving intravenous thrombolysis for different etiologies of AIS. Results A total of 381 patients were included. NLR was independently associated with unfavorable functional outcome for large-artery atherosclerosis stroke (aOR,1.354; 95% CI, 1.142–1.606; P = 0.001), small-artery occlusion stroke (aOR,1.505; 95% CI, 1.081–2.096; P = 0.015), and cardioembolism stroke (aOR,1.817; 95% CI, 1.065–3.101; P = 0.028). LMR was independently associated with poor functional outcome for large-artery atherosclerosis stroke (aOR, 0.693; 95% CI, 0.541–0.886; P = 0.004). NLR's AUC values for predicting poor functional outcome in large-artery atherosclerosis, small-artery occlusion and cardioembolism were 0.702, 0.750, and 0.697 respectively, with cutoff values of 3.193, 3.937, and 3.172. Conclusions NLR had good predictive ability for poor functional outcome of patients with large-artery atherosclerosis and small-artery occlusion strokes who received intravenous thrombolysis treatment, rather than other subtypes. LMR and PLR had no predictive values.