Admission neutrophil–lymphocyte ratio predicts 90 day outcome after endovascular stroke therapy

Abstract

Objective Immune dysregulation influences outcome following acute ischemic stroke (AIS). Admission white blood cell (WBC) counts are routinely obtained, making the neutrophil–lymphocyte ratio (NLR) a readily available biomarker of the immune response to stroke. This study sought to identify the relationship between NLR and 90 day AIS outcome. Methods A retrospective analysis was performed on patients who underwent endovascular therapy for AIS at West Virginia University Hospitals, Morgantown, West Virginia. Admission WBC differentials were analyzed as the NLR. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS) score and outcome by the modified Rankin Scale (mRS) score at 90 days. Univariate relationships between NLR, age, NIHSS, and mRS were established by correlation coefficients; the t test was used to compare NLR with recanalization and stroke location (anterior vs posterior). Logistic regression models were developed to identify the ability of NLR to predict mRS when controlling for age, recanalization, and treatment with IV tissue plasminogen activator (tPA). Results 116 patients were reviewed from 2008 to 2011. Mean age of the sample was 67 years, and 54% were women. Mean baseline NIHSS score was 17 and 90 day mRS score was 4. There was a significant relationship between NLR and mRS (p=0.02) that remained when controlling for age, treatment with IV tPA, and recanalization. NLR ≥5.9 predicted poor outcome and death at 90 days. Conclusions This study shows that the NLR, a readily available biomarker, may be a clinically useful tool for risk stratification when evaluating AIS patients as candidates for endovascular therapies.

The prediction of neutrophil to lymphocyte ratio for outcomes in ischemic stroke

“…However, after performing multivariate regression analysis, we found that the NLR was not an independent predictor for 90-day mortality with considering other factors. Compared with the 90-day poor outcomes, NLR was not an independent predictor for 90-day mortality and the risk of 90-day mortality was also influenced by other factors, such as age, history of myocardial infarction and National Institute of Health stroke scale (NIHSS) [20,21]. One study [21] found the history of myocardial infarction and NIHSS had a higher OR (2.26 and 1.18) for 90-day mortality, and the NLR had a weaker predictive ability with OR of 1.08.…”

“…Previous studies [18,33] reported some independent predictors for mortality, such as age, NIHSS and the volume of infarct. With multivariate regression analysis, Maestrini [20] and Brooks [21] adjusted the outcomes with onset-to-treatment, gender, atrial fibrillation, systolic BP, recanalization, application of tissue plasminogen activator (tPA), and they found that NLR was independently associated with 90-day mortality. The study [19] that used univariate regression analysis also suggested that NLR at admission is a prognostic biomarker in acute ischemic stroke.…”

“…A total of 8 studies [4,[17][18][19][20][21][22][23] of 3855 patients were included and the study characteristics of were listed in Table 1. All studies (2 prospective and 6 retrospective) were published between 2013 and 2017 with mean age from 62 to 70 years.…”

“…In addition, it is used to predict the prognosis of patients with various cancers [10,11], cardiovascular diseases [12,13] and hemorrhagic stroke [14][15][16]. Recently, NLR was used to predict in-hospital mortality [17,18], 90-day mortality [19][20][21] and 90-day poor outcomes (mRS≥3) [4,[21][22][23] in patients with ischemic stroke.…”

Immunopathogenetic Aspects of Ischemic Stroke

“…Как в экс-периментальных моделях, так и у человека ин-сульт сопровождается быстрым (в течение часов) возрастанием числа лейкоцитов в перифериче-ской крови и усилением экспрессии генов про-воспалительных медиаторов, что свидетельствует о развитии системной воспалительной реакции в ответ на ишемическое поражение мозга [32,86]. Системное воспаление проявляется значимым увеличением соотношения нейтрофилов и лим-фоцитов [136], величина которого является про-гностическим маркером 60-и 90-суточной ле-тальности при ишемическом инсульте [12,120].…”