Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis

Abstract

Background and PurposeMounting researches have illuminated that the neutrophil-related ratios were related to the prognosis of acute ischemic stroke (AIS). However, few have compared their predictive value and accuracy. To make such comparison and identify the best indicator on the 90-day outcome, we investigated biomarkers including neutrophil ratio (Nr), neutrophil count (Nc), lymphocyte (L), neutrophil-to-lymphocyte ratio (NLR), platelet (P or PLT), platelet-to-neutrophil ratio (PNR), NLR-to-platelet ratio (NLR/PLT), eosinophil (E), neutrophil-to-eosinophil ratio (NER), monocyte (M), and monocyte-to-neutrophil ratio (MNR).MethodsThis retrospective study recruited 283 AIS and 872 healthy controls (HCs) receiving intravenous thrombolysis (IVT). Blood samples were collected after 24 h of admission before IVT. Propensity Score Matching (PSM) was used to explore whether these ratios differentiated AIS and HCs. We applied univariate and multivariate analyses to evaluate the prediction effect of these ratios separately or added in the model and figured out a clinical prediction model. To estimate the discrimination and calibration of the new models, the receiver operating characteristics (ROC) curve analysis, DeLong method, and likelihood ratio test (LR test) were utilized.ResultsPSM showed that Nr, Nc, NLR, P, PNR, NLR/PLT, NER, and MNR facilitates the differentiation of the HCs and AIS. Among the eight biomarkers, PNR and MNR could differentiate the 90-day outcome, and it was found out that PNR performed better. Univariate regression analysis demonstrated that PNR was the only independent predictor which needs no adjustment. Besides, the multivariate regression analysis, Delong method, and LR test indicated that among the neutrophil-related ratios, NLR, PNR, NLR/PLT, NER, and MNR exerted little influence on the discrimination but could enhance the calibration of the base model, and NER proved to work best.ConclusionLow PNR was the best indicator among the neutrophil-related ratios tin predicting a poor 90-day outcome of AIS patients. Moreover, high NER performed best when predicting the 90-day outcome to improve the calibration of the base model.

High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: A single-center retrospective study in China

“…The NLR as a marker of systemic inflammation is more responsive to clinical significance than neutrophils and lymphocytes alone, and it is useful ( 30 ), low cost, and widely used, thereby having excellent clinical potential. We assessed the diagnostic value of neutrophil percentage and NLR quintile for PSCI by ROC curves separately and found that the diagnostic accuracy was 58.3–59.0%; at the same time, the sensitivity and specificity were fair at 45.8–68.2%.…”

Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry

“…Elevated leukocyte and neutrophil levels might release inflammatory mediators, such as proteases and reactive oxygen species, exacerbating brain tissue damage and edema 5 27. The increased number of neutrophil extracellular traps might also promote thrombosis and ultimately lead to EVT resistance 21.…”

“…All of the blood samples were collected before EVT. We documented neutrophil count (N),12 13 white blood cell count (W),13 eosinophil count (E),14 monocyte count (M),5 lymphocyte count (L),5 and platelet count (P/PLT),5 and calculated the following according to the above indicators: neutrophil to lymphocyte ratio (NLR),4 platelet to lymphocyte ratio (PLR),4 platelet to neutrophil ratio (PNR),5 6 platelet to white blood cell ratio (PWR)6, platelet to monocyte ratio (PMR),15 lymphocyte to monocyte ratio (LMR),16 monocyte to neutrophil ratio (MNR),5 eosinophil to lymphocyte ratio (ELR),17 and eosinophil to monocyte ratio (EMR) 18. NLR to platelet ratio (NLR/PLT) was calculated as the value of the ratio of NLR to platelets 19…”

“…Mounting research has shown that inflammatory responses exacerbate ischemic brain injury and neurological dysfunction 4. Leukocytes and their subtypes, as common inflammatory markers, have been shown to be associated with infarct size, stroke severity, and poor prognosis 5. Moreover, composite inflammatory ratios, as novel biomarkers in systemic inflammation, have also been shown to have diagnostic and predictive values in patients with ac-LVO 6–8…”

Commentary: Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis

“…In a recent study ( Gao et al, 2021 ), investigated the neutrophil-related ratios in patients with acute ischemic stroke after thrombosis. After adjusting for confounders, they reported several granulocyte parameters were independently associated with 90-day outcomes.…”