Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke

Duan, Zhenhui; Wang, Huaiming; Wang, Zhen; Hao, Yonggang; Zi, Wenjie; Yang, Dong; Zhou, Zhiming; Liu, Wenhua; Lin, Min; Shi, Zhonghua; Lv, Penghua; Wan, Yue; Xu, Gelin; Xiong, Yunyun; Zhu, Wusheng; Liu, Xinfeng; Investigators, Actual

doi:10.1159/000489401

Cited by 72 publications

(54 citation statements)

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“…Clinical evidences have shown that, in AIS patients, high NLR levels are associated with increased infarct volume and mortality (Celikbilek, Ismailogullari, & Zararsiz, 2014;Gökhan et al, 2013;Tokgoz et al, 2013). Furthermore, NLR is a predictor of recurrent ischemic stroke and 90-day poor functional outcome in AIS patients receiving endovascular stroke therapy or IVT or antiplatelet medications (Brooks et al, 2014;Duan et al, 2018;Malhotra et al, 2018;Qun et al, 2017). In the present study, it is the first time to investigate the relationship between NLR and early functional deterioration in AIS patients with IVT therapy.…”

Section: Discussionmentioning

confidence: 67%

“…Neutrophil, the main inflammatory cell of AIS, on one hand, can release free oxygen radicals propagating secondary brain injury in penumbra regions (Ceulemans et al, 2010 TA B L E 5 (Continued) (Continues) neutrophils are the source of matrix metalloproteinase-9 (MMP-9), which can directly result in blood-brain barrier (BBB) breakdown and hemorrhagic transformation (Duan et al, 2018). These may be significant contributors in the occurrence of END.…”

Section: Discussionmentioning

confidence: 99%

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Neutrophil–lymphocyte ratio predicts post‐thrombolysis early neurological deterioration in acute ischemic stroke patients

et al. 2019

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Background and purpose Intravenous thrombolysis (IVT) has become the standard treatment for acute ischemic stroke within 4.5 hr after symptoms onset. However, a fraction of patients would develop early neurological deterioration (END) after IVT. The aim of our study was to explore the utility of neutrophil–lymphocyte ratio (NLR) in predicting END. Methods From October 2016 to March 2018, 342 consecutive patients with thrombolytic therapy were prospectively enrolled in this study. Blood cell counts were sampled in stroke emergency room before IVT. END was defined as a National Institutes of Health Stroke Scale score increase of ≥4 points within 24 hr after IVT. Multiple regression analysis was used to investigate the potential risk factors of END. We also performed receiver operating characteristic curve analysis and nomogram analysis to assess the overall discriminative ability of the NLR in predicting END. Results Of the 342 patients, 86 (25.1%) participants were identified with END. Univariate logistic regression analysis demonstrated that patients with NLR in the third tertile, compared with the first tertile, were more likely to have END (odds ratio, 9.783; 95% confidence interval [CI], 4.847–19.764; p = .001). The association remained significant even after controlled for potential confounders. Also, a cutoff value of 4.43 for NLR was detected in predicting post‐thrombolysis END with a sensitivity of 70.9% and a specificity of 79.3% (area under curve, 0.779; 95% CI, 0.731–0.822). Furthermore, our established nomogram indicated that higher NLR was an indicator of post‐thrombolysis END (c‐index was 0.789, p < .001). Conclusions This study showed that elevated level of NLR may predict post‐thrombolysis END in ischemic stroke patients.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Neutrophil–lymphocyte ratio predicts post‐thrombolysis early neurological deterioration in acute ischemic stroke patients

et al. 2019

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“…Of the remaining 26 articles, 19 were removed due to being reviews ( n = 3) and not reporting relevant outcomes ( n = 16). Seven articles were eventually included in our meta‐analysis (Duan et al, ; Goyal et al, ; Guo et al, ; Maestrini et al, ; Malhotra et al, ; Pikija et al, ; Song et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies have shown that the NLR is independently associated with clinical outcomes and short‐term mortality in patients with AIS (Gokhan et al, ; Tokgoz, Keskin, Kayrak, Seyithanoglu, & Ogmegul, ; Yu et al, ; Zhang et al, ). In addition, it was reported that a higher admission NLR is an independent risk factor for HT and 3‐month functional outcome in patients with AIS both with and without reperfusion therapy (Duan et al, ; Goyal et al, ; Guo et al, ; Maestrini et al, ; Pikija et al, ; Song et al, ). The subject of our study was to comprehensively summarize the value of NLR for predicting HT in patients with AIS by performing a meta‐analysis.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio predicts hemorrhagic transformation in ischemic stroke: A meta‐analysis

Zhang

Xiao-dong

et al. 2019

Brain and Behavior

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Introduction The neutrophil‐to‐lymphocyte ratio (NLR) has been shown to be a marker associated with inflammation and is independently associated with the adverse clinical outcomes of symptomatic intracranial hemorrhage, cancer, and cardiovascular disease. Hemorrhagic transformation (HT) is a serious complication of ischemic cerebral infarction and can be intensified by therapeutic interventions for acute ischemic stroke (AIS). The purpose of our research was to explore the predictive effect of NLR for HT in patients with AIS and to determine the best predictive value. Methods PubMed, Web of Science, EMBASE, MEDLINE, Cochrane, and Google Scholar were searched. The primary endpoint was HT, and subgroup analysis was performed. Review Manager software version 5.3 was used to statistically analyze the outcomes. Results A total of seven studies including 3,726 patients met the inclusion criteria. The pooled odds ratio (OR) value of the high NLR that predicted HT in AIS patients was 1.53 (95% CI, 1.21–1.92; p = .0003). In addition, 1.10 (95% CI, 1.05–1.15; p < .0001) was the pooled OR of the high NLR associated with increased 3‐month mortality in patients with AIS. In the subgroup analysis with an NLR cutoff value of 7.5–11, the correlation between NLR above the cutoff value and the rate of HT in patients with AIS was statistically significant (OR, 7.93; 95% CI, 2.25–27.95; p = .001). Conclusion A high NLR can predict HT and 3‐month mortality in patients with AIS. Regardless of the country of origin and the sampling time, an NLR with a cutoff value of 7.5–11 was independently associated with HT in AIS patients.

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“…Recent studies suggested that inflammatory mediators have significant clinical significance in AIS and HT [6,7]. Neutrophil-to-lymphocyte ratio (NLR) is a rather new risk determinant factor of the inflammatory response that has been shown to be associated with the severity and prognosis of cardiovascular events, ischemic stroke, cancer, and bacterial infectious disease [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte Ratio as a Risk Determinant of Hemorrhage Transformation in Acute Ischemic Stroke

Bilal

Shu

et al. 2020

JMN

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Objective: The purpose of this study was to investigate the clinical significance between neutrophil-to-lymphocyte ratio (NLR) and classification of non-thrombolytic hemorrhagic transformation (HT) in acute ischemic stroke (AIS), to unravel new diagnostic approach. Methods: We recruited and selected 636 patients who did not undergo thrombolytic therapy between May 2018 and April 2019 at the Affiliated Hospital of Xuzhou Medical University. The laboratory and clinical data were collected within 24 h after the onset of AIS. Based on the status of HT development during hospitalization, all participants were divided into three groups, namely, the non-HT (NHT) group, hemorrhagic infarction (HI) group, and parenchymal hematoma (PH) group. Results: Multivariate logistic regression analysis showed that NLR and the ischemic lesion diameter are independent risk factors of HI and PH, while the score of National Institutes of Health Stroke Scale (NIHSS) and cardioembolism are considered to be independent risk factors for PH only. Receiver operating characteristic (ROC) analysis determined that the optimal cutoff values of NLR in HI group and PH group were 3.75 and 3.97, respectively. The optimal cutoff value can be used as the critical value for the unfavorable outcome. Conclusion: NLR values were significantly increased and correlated with both HI and PH groups and NLR could be used as a predictor of both HI and PH.

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Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke

Cited by 72 publications

References 30 publications

Neutrophil–lymphocyte ratio predicts post‐thrombolysis early neurological deterioration in acute ischemic stroke patients

Neutrophil–lymphocyte ratio predicts post‐thrombolysis early neurological deterioration in acute ischemic stroke patients

Neutrophil‐to‐lymphocyte ratio predicts hemorrhagic transformation in ischemic stroke: A meta‐analysis

Neutrophil-to-lymphocyte Ratio as a Risk Determinant of Hemorrhage Transformation in Acute Ischemic Stroke

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