Neutrophil-to-Lymphocyte Ratio Predicts Cerebral Edema and Clinical Worsening Early After Reperfusion Therapy in Stroke

Abstract

Background and Purpose: The mechanisms linking systemic inflammation to poor outcome in ischemic stroke are not fully understood. The authors investigated if peripheral inflammation following reperfusion therapy leads to an increase in cerebral edema (CED), thus hindering the clinical recovery. Methods: We designed a single-center study conducted at Centro Hospitalar Universitário São João between 2017 and 2019. Inclusion criteria were being adult, having an anterior circulation acute ischemic stroke, and receiving reperfusion therapy. Neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios, and the systemic inflammatory response syndrome criteria were determined. The presence and grade of CED were evaluated on the computed tomography performed 24 hours following event. The clinical outcomes included early neurological deterioration and functional dependence at 90 days. Adjusted odds ratio and 95% CI were obtained by ordinal and logistic regression models. Optimal cutoff values were defined using receiver operating characteristic analysis in the training cohort and validated in an independent data set. Results: Five hundred fifty-three patients were included. Neutrophil-to-lymphocyte increased with higher degrees of CED at 24 hours (adjusted odds ratio, 1.34 [1.09–1.68], P <0.01) and was associated with early neurological deterioration (adjusted odds ratio, 1.30 [1.04–1.63], P <0.05) and poor functional status at 90 days (adjusted odds ratio, 1.79 [1.28–2.48], P <0.01). Platelet-to-lymphocyte was not associated with the outcomes. Systemic inflammatory response syndrome was related to CED due to altered white blood cell counts. Neutrophil-to-lymphocyte was the best predictor with an area under the curve around 0.7. Neutrophil-to-lymphocyte ≥7 had and accuracy, sensitivity, and specificity around 60%. Conclusions: Increased systemic inflammation is linked to the severity of CED early after reperfusion therapy in stroke. Easily obtained inflammatory markers convey early warning alerts for patients at risk of severe neurological complications with an impact on long-term functional outcome. CED quantification should be included as an end point in proof-of-concept trials in immunomodulation in stroke.

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

“…Various studies have shown that NLR is closely related to AIS dysfunction, short-term mortality, stroke severity on admission, primary unfavorable functional outcome, recurrent ischemic stroke and post stroke infections, greater risk of symptomatic intracranial hemorrhage, poor 3-month functional outcome, and 3-month mortality in AIS patients undergoing reperfusion treatments, which is consistent with our results (Xue et al, 2017;Kocaturk et al, 2019;Chen et al, 2020;Giede-Jeppe et al, 2020;He et al, 2020;AltinbaŞ et al, 2021;Bi et al, 2021;Ferro et al, 2021;Gong et al, 2021;Hu et al, 2021;Huang et al, 2021;Lin et al, 2021). In a recent study, NLR ≥ 9 was an independent predictor of new in-hospital neurologic complications (Heuschmann et al, 2004).…”

The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage

“…A number of studies have shown that NLR was predictive of short-term functional outcome in acute ischemic stroke (AIS) (116). A high NLR was also found to be an independent predictor for the complications following AIS including cerebral edema (117), hemorrhagic transformation after ischemia (118), and the development of ICH after endovascular treatment (119).…”

Neutrophil-to-lymphocyte ratio is associated with increased cerebral blood flow velocity in acute bacterial meningitis

“…Reasons for this finding may be the small cohort size. According to recently published data, NLR represents a promising marker in stroke for the prediction of symptomatic hemorrhagic transformation (sHT) undergoing revascularization 45 and cerebral edema after reperfusion therapy 46 .…”