Platelet-to-lymphocyte ratio at 24h after thrombolysis is a prognostic marker in acute ischemic stroke patients

Abstract

Introduction: The role of Platelet-to-lymphocyte ratio (PLR) in outcomes of acute ischemic stroke, especially before and after intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA), has not been elucidated. Thus, the aim of this study was to evaluate the effect of PLR before and after rtPA on clinical outcomes.Methods: A total of 582 consecutive patients who had acute ischemic stroke diagnosed and received intravenous thrombolysis with rtPA were included in this study. We collected demographics, vascular risk factors, previous history of drugs and other clinical information for all patients. Specifically, blood samples for PLR values were collected on admission and at 24 hours after stroke. Multivariate logistic regression analysis was used to assess the association between PLR with the risk of poor outcome (mRS≥3), death and hemorrhagic transformation (HT). Results: Of 582 patients, 191 (32.8%) had a poor outcome, 40 (6.9%) died and 82 (14.1%) had HT. After adjustment for potential confounders, multivariate logistic regression analysis showed that higher PLR at 24h after rtPA was independently associated with an increased risk of poor outcome (OR=1.004; 95% CI:1.001-1.007; P=0.009) and the occurrence of death (OR=1.009; 95% CI:1.004-1.013; P<0.001), but not associated with the risk of HT (OR=1.003; 95% CI:0.999-1.007; P=0.165). In addition, PLR on admission was not associated with the risk of poor outcome, death and HT (all P>0.05).Conclusions: We found that PLR at 24h after rtPA can predict the risk of poor outcome and death in acute ischemic stroke patients, but PLR on admission cannot.

Prognostic Role of the Platelet-Lymphocyte Ratio in Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy: A Meta-Analysis

“…Very few studies considered the association of dynamic PLR changes with outcomes, and thus, this could not be analysed. Finally, not all studies 12 , 13 , 17 , 22 , 34 , 35 excluded patients with active infection, malignancy, or chronic disease, which can influence lymphocyte count via systemic inflammation. 4 , 10 …”

“…7,8 It is particularly promising as it could potentially provide insight into both inflammation and thrombotic/hemostatic mechanisms thought to play a role in AIS pathogenesis, whereas other biomarkers shown to have prognostic value such as C-Reactive Protein, platelet count and the neutrophil-lymphocyte ratio encompass only one of these mechanisms. 4,[9][10][11] While there has been some evidence showing benefit of PLR in predicting clinical outcomes, [12][13][14][15][16][17][18][19] mortality 12,16,17,[19][20][21] and bleeding risk 12,17,18,22,23 in AIS patients treated with reperfusion therapy (RT), this is yet to be clearly elucidated; to the best of our knowledge there is no systematic review or meta-analysis currently in the literature evaluating this. As such, this study aims to investigate the association of PLR at admission and PLR collected at delayed timepoints through a systematic review and meta-analysis of published literature, and to gauge the clinical utility thereof in prognostication and clinical decision-making.…”