Systemic Inflammation Indices in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator: Clinical Yield and Utility

Topçuoğlu, Mehmet Akif; Pektezel, Mehmet Yasir; Yılmaz, Ezgi; Arsava, Ethem Murat

doi:10.1177/0003319720969997

Cited by 20 publications

(27 citation statements)

References 34 publications

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“…A meta-analysis could not be performed. However, a systematic review indicated that a higher admission PLR could be associated with radiological bleeding, with both Ferro et al 23 and Topcuoglu et al 18 reporting this. Ferro et al‘s results, split into grades of radiological bleeding, while significant in univariate analyses, did not provide a significant result in multivariate modelling.…”

Section: Resultsmentioning

confidence: 99%

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

Sharma

Bhaskar

2022

J Cent Nerv Syst Dis

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Background Both inflammation and thrombotic/hemostatic mechanisms may play a role in acute ischemic stroke (AIS) pathogenesis, and a biomarker, such as the platelet-to-lymphocyte ratio (PLR), considering both mechanisms may be of clinical utility. Objectives This meta-analysis sought to examine the effect of PLR on functional outcomes, early neurological changes, bleeding complications, mortality, and adverse outcomes in AIS patients treated with reperfusion therapy (RT). Design Systematic Review and Meta-Analysis Data Sources and Methods Individual studies were retrieved from the PubMed/Medline, EMBASE and Cochrane databases. References thereof were also consulted. Data were extracted using a standardised data sheet, and systematic reviews and meta-analyses on the association of admission (pre-RT) or delayed (post-RT) PLR with defined clinical and safety outcomes were conducted. In the case of multiple delayed PLR timepoints, the timepoint closest to 24 hours was selected. Results Eighteen studies (n=4878) were identified for the systematic review, of which 14 (n=4413) were included in the meta-analyses. PLR collected at admission was significantly negatively associated with 90-day good functional outcomes (SMD=−.32; 95% CI = −.58 to −.05; P=.020; z=−2.328), as was PLR collected at delayed timepoints (SMD=−.43; 95% CI = −.54 to −.32; P<.0001; z=−7.454). PLR at delayed timepoints was also significantly negatively associated with ENI (SMD=−.18; 95% CI = −.29 to −.08; P=.001. Conversely, the study suggested that a higher PLR at delayed timepoints may be associated with radiological bleeding and mortality. The results varied based on the type of RT administered. Conclusions A higher PLR is associated with worse outcomes after stroke in terms of morbidity, mortality, and safety outcomes after stroke.

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Section: Resultsmentioning

confidence: 99%

“…A lower delayed PLR was observed in patients with ENI in both studies included in the systematic review, but this reached statistical significance only in the results of Topcuoglu et al and not Inanc & Inanc. 18 , 21…”

Section: Resultsmentioning

confidence: 99%

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

Sharma

Bhaskar

2022

J Cent Nerv Syst Dis

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“…In another study, SII was associated with 90-day functional outcome [ 62 ]. In patients submitted to IVT, an increased 24-h SII was associated with poor functional outcome [ 63 ].…”

Section: Resultsmentioning

confidence: 99%

Acute Inflammation in Cerebrovascular Disease: A Critical Reappraisal with Focus on Human Studies

Dias

Azevedo

et al. 2021

Life

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Recent attention has been focused on the field of inflammatory biomarkers associated with vascular disorders, regarding diagnosis, prognosis, and possible therapeutical targets. In this study, we aimed to perform a comprehensive review of the literature regarding the use of inflammatory biomarkers in stroke patients. We searched studies that evaluated inflammation biomarkers associated with Cerebrovascular Disease (CVD), namely, ischemic Stroke (IS), Intracerebral Hemorrhage (ICH) and Cerebral Venous Thrombosis (CVT). As of today, neutrophil–lymphocyte ratio (NLR) seems the be the most widely studied and accepted biomarker for cerebrovascular disease due to its easy access and availability. Although demonstrated as a prognostic risk factor, in IS, ICH and CVT, its diagnostic role is still under investigation. Several other prognostic factors could be used or even combined together into a diagnostic or prognostic index. Multiple inflammatory biomarkers appear to be involved in IS, ICH, and CVT. Blood inflammatory cells, easily measured and accessible at admission may provide information regarding accurate diagnosis and prognosis. Although not yet a reality, increasing evidence exists to suggest that these may become potential therapeutic targets, likely influencing or mitigating complications of CVD and improving prognosis. Nevertheless, further larger, well-designed randomized clinical trials are still needed to follow up this hypothesis.

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“…For the SII index, ROC-AUC was 0.802, sensitivity was 58.7%, and specificity was 72.7%. As a result, it was concluded that the SII index and NLR provided moderate benefit in predicting the risk of bleeding that might occur following thrombolytic therapy (24). Similarly, it was emphasized that the SII index was a marker that predicted hemorrhagic transformation in patients who had a stroke due to large artery atherosclerosis of anterior circulation (25).…”

Section: Discussionmentioning

confidence: 99%

Is the systemic immune-inflammation index a predictive marker of carotid artery stenosis?

GÖLEN¹,

OKUYAN²

2022

Journal of Health Sciences and Medicine

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Introduction:The relationship between inflammation and atherosclerosis and ischemic stroke was shown in studies, and we aimed to evaluate the relationship between the systemic immune-inflammation (SII) index and carotid artery stenosis (CAS) in our study. Material and Method: Forty patients with CAS with acute cerebrovascular disease and sixty three patients without CAS with acute cerebrovascular disease were included in the study. Demographic characteristics, neutrophil/lymphocyte ratio ( NLR), and the SII indexes of the patients were compared between the groups with and without CAS. Results: There was a statistically significant difference between the groups in terms of NLR and SII index values (p<0.05). In the ROC analysis, the sensitivity of the SII index was 65% and the specificity was 84.1%, based on a cut-off value of ≥14.032, and the sensitivity and specificity of NLR were 65% and 82.5%, repectively, based on a cut-off value ≥4.701. In terms of prognosis, poor outcome (mRS 3-6) was detected in 22/40 (55%) in the group with CAS, and a statistically significant difference was found between the groups (p<0.05). When evaluated in terms of mortality, the 1-month mortality rate in the group with CAS was 20% (8/40), and 4.8% (3/63) in the group without CAS (p<0.05). Conclusion:In our study, the SII index and NLR were thought to be markers associated with the presence of CAS in patients with symptomatic CAS, and higher NLR and SII index values were found to be associated with poor prognosis and mortality.

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Systemic Inflammation Indices in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator: Clinical Yield and Utility

Cited by 20 publications

References 34 publications

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

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

Acute Inflammation in Cerebrovascular Disease: A Critical Reappraisal with Focus on Human Studies

Is the systemic immune-inflammation index a predictive marker of carotid artery stenosis?

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