A high neutrophil-to-lymphocyte ratio predicts hemorrhagic transformation of large atherosclerotic infarction in patients with acute ischemic stroke

Abstract

Increasing evidence suggests that inflammation is associated with the development of acute ischemic stroke (AIS). The neutrophil-to-lymphocyte ratio (N/L) is an important marker of inflammation and is highly correlated with mortality in stroke patients in recent studies. The N/L of patients who experience hemorrhagic transformation (HT) after AIS is know, but any relationship between N/L and large artery atherosclerosis (LAA) remains unclear, this is our present topic. We enrolled 185 patients with LAA-type HT in the development cohort from a prospective, consecutive, hospital-based stroke registry to this end. We matched these patients to 213 LAA patients who did not develop HT as controls. The incidence of HT after LAA was significantly greater (P<0.01) in patients with higher N/L. We developed a predictive nomogram (incorporating age, systolic blood pressure, the National Institutes of Health Stroke Scale, and the N/L) for LAA patients. The predictive power was good (area under the curve, AUC: 0.832, 95%CI: 0.791-0.872). Our findings were further validated in a validation cohort of 202 patients with AIS attributable to LAA (AUC:0.836, 95%CI:0.781-0.891). In summary, a high N/L is associated with an increased risk for HT after LAA.

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

“…Previous studies exhibited that NLR, PLR, and LMR could predict the clinical outcome in AIS patients [ 16 , 18 , 40 ]. NLR and LMR can also foretell HT after ischemic stroke [ 41 , 42 ]. Moreover, high NLR and PLR might be associated with symptomatic internal carotid artery stenosis [ 43 ].…”

Systemic Inflammation Indices in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator: Clinical Yield and Utility

“…[14][15][16][17][18] Association of NLR and LMR with hemorrhagic transformation was also noted in patients who did not receive IV tPA. [19][20][21] Now, we have been extended this observation to other indices. In addition, although we used very stringent criteria, we were able to detect clinically useful, albeit moderate, thresholds for both NLR (6.65) and SII (1781) for PH2 type hemorrhage occurrence after IV tPA (Supplementary Table 2).…”

Cardiogenic Parameters Effectively Predict Hemorrhagic Transformation in Patients with Non-Large Artery Atherosclerosis Infarction

“…The external validation was then a cohort of patients from the same center at different time periods. In our previous study, neutrophil-to-lymphocyte ratio was found to be one of the risk factors for HT in patients with LAA, and the model developed accordingly had an AUC of 0.832, which also predicted the outcome well for both PH and HI (8). In another study of ours, it was found that cardiogenic parameters were risk factors for worse prognosis of patients with non-LAA AIS, the nomogram based on cardiogenic parameters and NIHSS scores established was a good predictor of the prognosis of patients with non-LAA,and its AUC reached 0.954 (9).…”