Early prediction of severity in acute ischemic stroke and transient ischemic attack using platelet parameters and neutrophil‐to‐lymphocyte ratio

Abstract

Background It is still not easy to predict severity promptly in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA). We investigated that platelet parameters or combinations of them could be a useful tool for early prediction of severity of AIS and TIA at admission and after 3 months. Methods We prospectively recruited 104 patients newly diagnosed with AIS and TIA. We investigated their neutrophil‐to‐lymphocyte ratio (NLR) and platelet parameters. According to the Modified Rankin Scale scores, the patients were divided into two groups. Results In receiver operating characteristic (ROC) curve analyses, mean platelet volume (MPV), NLR/platelet count (PLT), MPV/PLT, MPV*NLR, and MPV*NLR/PLT showed statistically significant results in both at admission and after 3 months. Values of area under ROC curves for those tests at admission were 0.646, 0.697, 0.664, 0.708, and 0.722, respectively. Also, values after 3 months were 0.591, 0.661, 0.638, 0.662, and 0.689, respectively. Conclusion MPV*NLR/PLT could be used as a relatively good tool for predicting severity at the time of admission and after 3 months than other parameters or combinations of them. Further studies have to be carried out to investigate the best parameter for predicting the severity of AIS and TIA.

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

“…Furthermore, elevated D-dimer and hyperfibrinogenemia, which are both biomarkers of inflammation and hypercoagulable state, have also been shown to predict the severity of the said infection (31,32). Interestingly, similar biomarkers predict outcomes in stroke (33)(34)(35)(36)(37)(38)(39). In particular, it is known that patients who show elevated NLR, ferritin, CRP, D-dimer and fibrinogen have a higher risk for stroke and equate to potentially poorer clinical outcomes (33)(34)(35)(36)(37)(38)(39).…”

Universally Available Innate and Adaptive Immune Cell Counts in Acute Ischemic Stroke (AIS) in the Context of Shared Pathobiology with COVID-19; Scoping Review

“…NLR has been identified to be a useful clinical predictor of outcome in AIS patients being considered for mechanical thrombectomy, as NLR can predict functional dependence and mortality after adjustment for potential confounders that included vascular risk factors. Multiple analyses reveal NLR correlates with a greater functional disability at admission and at three months (increased mRS and NIHSS scores) and increased 90-day mortality (21)(22)(23)(24)(25)(26)(27) and was furthermore associated with length of hospital stay (28) and cost (29). Patients with NLR >3.3 were 2-times more likely to be at risk of death (24).…”

Leukocyte Biomarkers for the Differential Diagnosis of Mild Acute Ischemic Stroke, Transient Ischemic Attack, and Stroke Mimic

“…Furthermore, several of these studies have combined AIS and TIA into a single group for comparison. For example, Ross et al and Lim et al compared immune cell counts between AIS and TIA versus control, and while both studies reported significantly increased neutrophil percentage and decreased lymphocyte percentage in AIS and TIA compared to control, neither of these studies compared AIS to control [ 3 - 4 ]. Gökhan et al reported that the neutrophil count and neutrophil-lymphocyte ratio (NLR) were significantly higher in AIS compared to TIA [ 5 ].…”