Prognostic value of neutrophil to lymphocyte ratio in acute ischemic stroke after reperfusion therapy

AbstractThe purpose of this study was to investigate whether baseline neutrophil to lymphocyte ratio (NLR) was an independent predictor for early symptomatic intracranial hemorrhage (sICH), poor functional outcome and mortality at 3 months after reperfusion therapy in acute ischemic stroke (AIS) patients. Using PubMed and EMBASE, we searched for literature published before January 19th, 2019. Two reviewers independently confirmed each study’s eligibility, assessed risk of bias, and extracted data. One reviewer combined studies using random effects meta-analysis. 9 studies with 3651 patients were pooled in the meta-analysis. Overall, baseline NLR levels were greater in patients with poor outcome. The standardized mean difference (SMD) in the NLR levels between patients with poor functional outcome (mRS > 2) and good functional outcome (mRS ≤ 2) was 0.54 units (95% credible interval [CI] [0.38, 0.70]). Heterogeneity test showed that there were significant differences between individual studies (p = 0.02; I2 = 72.8%). The NLR levels were associated with sICH in four included studies (n = 2003, SMD = 0.78, 95% [CI] [0.18, 1.38], I2 = 73.9%). Higher NLR levels were positively correlated with 3-month mortality (n = 1389, ES = 1.71, 95% CI [1.01,2.42], p < 0.01, I2 = 0%) when data were used as categorical variables. Our meta-analysis suggests that increased NLR levels are positively associated with greater risk of sICH, 3-month poor functional outcome and 3-month mortality in AIS patients undergoing reperfusion treatments. Although there are some deficits in this study, it may be feasible to predict the prognosis of reperfusion therapy in AIS patients with NLR levels.

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Prognostic Value of Neutrophil To Lymphocyte Ratio In Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis: A Meta-Analysis

10.21203/rs.3.rs-189563/v1 ◽

2021 ◽

Author(s):

Chengbing Wang ◽

Qian Zhang ◽

Mingwei Ji ◽

Jing Mang ◽

Zhongxin Xu

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Poor Prognosis ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Poor Functional Outcome ◽

Lymphocyte Ratio ◽

Increased Risk ◽

The Relationship

Abstract Background: The neutrophil to lymphocyte ratio (NLR) has been shown to be an important independent inflammatory indicator in stroke. The relationship between NLR and poor prognostics in acute ischemic stroke (AIS) patients who received intravenous thrombolysis (IVT) still unclear. The purpose of this meta-analysis was to evaluate the association between NLR and poor prognosis after IVT. Furthermore, we aim to concluded whether admission NLR or post-IVT NLR play a role in AIS.Methods: Pubmed, Embase, Wed of Science and China National Knowledge Infrastructure were searched for relevant articles until October 7, 2020. Cohort and case-control studies were included if related to NLR in AIS patients treated with IVT. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were pooled to estimate the relationship between NLR and poor prognosis after IVT. A random effects model was used to calculate the pooled data.Results: Twelve studies, including 3641 patients met the predefined inclusion criteria. Higher NLR levels were associated with an increased risk of hemorrhagic transformation (HT) (OR=1.33,95%CI=1.14-1.56, P<0.001) and 3-month poor functional outcome (OR=1.64,95%CI=1.38-1.94, P<0.001) in AIS patients receiving IVT. Subgroup analysis of HT suggested that admission NLR levels rather than post-IVT NLR levels was associated with higher risk of HT (OR=1.33,95%CI=1.01-1.75, P=0.039). But There had no statistically significant difference between higher NLR levels and 3-month mortality (OR=1.14, 95%CI=0.97-1.35, P=0.120).Conclusions: High NLR can predict HT and 3-month poor functional outcome in AIS patients received IVT. Admission NLR rather than post-IVT NLR was independent risk factor of increased risk of HT.

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Neutrophil Lymphocyte Ratio as a Prognostic Marker in Acute Ischemic Stroke: a Systematic Review and Meta-analysis

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i4.3143 ◽

2021 ◽

Vol 18 (4) ◽

pp. 573-579

Author(s):

Subodh Sharma Paudel ◽

Bikram Thapa ◽

Ritesh Luitel

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Prognostic Marker ◽

Meta Analysis ◽

Forest Plot ◽

Poor Functional Outcome ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

The Poor

Background: Acute ischemic stroke leads to an inflammatory response and the neutrophil-to-lymphocyte ratio is an inflammatory indicator for determining prognosis in acute ischemic stroke. This meta-analysis aims to show evidence that neutrophil-to-lymphocyte can act as an independent and early prognostic marker in cases of acute ischemic stroke. Methods: Databases of PubMed, and Embase were searched for literature. Relevant data were extracted by SSP and BT from eligible literature. Odds ratios with 95% confidence intervals were pooled and a Forest plot was used to evaluate the prognostic value of neutrophil-to-lymphocyte in acute ischemic stroke. Modified Rankin Scale ? 3 was defined as a poor functional outcome. A funnel plot is used to show the symmetric distribution and no publication bias. Results: According to Joanna Briggs Institute assessment for analytical observational studies, the studies included are of fair to good quality. Eight relevant studies with 3011 patients were included, one with no data on OR. The pooled OR of 6 studies with the poor functional outcome at 3 months was 1.47(P<0.02 95%CI: 1.40-2.31) while one study with the poor functional outcome at discharge was OR=2.49. Conclusions: In patients with acute ischemic stroke, elevated neutrophil-to-lymphocyte correlates with poorer functional outcome and increased chances of developing symptomatic Intracranial Hemorrhage. Baseline neutrophil-to-lymphocyte can be an inexpensive and easily available biomarker, especially in resource-poor settings, for predicting clinical outcomes in patients with ischemic stroke. Keywords: Ischemic stroke; lymphocyte; neutrophil; prognosis.

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The Predictive Effect of Mean Platelet Volume (MPV) and Neutrophil-to-Lymphocyte Ratio (NLR) on the Functional Outcome of Acute Ischemic Stroke

The Medical Journal of Cairo University ◽

10.21608/mjcu.2018.62792 ◽

2018 ◽

Vol 86 (12) ◽

pp. 4107-4113

Author(s):

ABEER A. TONY, M.D.; EFFAT A.E. TONY, M.D. ◽

WAFAA S. MOHAMMED, M.D.; EMAD F. KHOLEF, M.D.

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Mean Platelet Volume ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet Volume ◽

Lymphocyte Ratio ◽

Predictive Effect

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Abstract WP168: Neutrophil to Lymphocyte Ratio is a Useful Predictor of Short-term Functional Outcome in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp168 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Tae Jung Kim ◽

Min-Kyung Kang ◽

Kiwoong Nam ◽

Heejung Mo ◽

Sang Joon An ◽

...

Keyword(s):

Ischemic Stroke ◽

Cardiovascular Diseases ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Unfavorable Outcome ◽

Neutrophil To Lymphocyte Ratio ◽

Short Term ◽

Lymphocyte Ratio ◽

Outcome Group ◽

History Of

Introduction: Inflammation is associated with the initiation and progression of cardiovascular diseases. The neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a prognostic marker in cardiovascular diseases. However, impact of NLR on the functional outcome in patients with ischemic stroke remains unclear. Hypothesis: The aim of the study was to investigate the prognostic role of the NLR in patients with acute ischemic stroke. Methods: A consecutive 1,113 patients who were admitted within 7 days after ischemic stroke onset between March 2010 and December 2014 were included for analysis. The patients were categorized into tertiles on the basis of NLR. We evaluated the short-term outcomes using a modified Rankin Scale (mRS) at three-months after onset of ischemic stroke. We divided patients into two groups with favorable outcome (mRS score ≤2) and unfavorable outcome (mRS score ≥3). We compared the clinical characteristics and NLR between two groups. Results: From all the patients included in this study (mean age, 67.8 years; men, 60.0%), 284 (25.5%) patients had unfavorable outcome. The patients with unfavorable outcome were older and more likely to have atrial fibrillation, history of previous stroke, and diabetes mellitus. In addition, participants with unfavorable outcome tended to have lower body mass index and higher initial NIHSS. The percentage values of the tertile 3 were significantly higher in the unfavorable outcome group (28.3% vs. 47.9%, P < 0.001). After adjustment for covariates, the highest tertile were at an exaggerated risk for unfavorable outcome [Odds ratio (95% confidence interval); tertile 3, 1.75 (1.17 - 2.63), P = 0.007]. Conclusions: This study demonstrated that higher NLR predicted worse outcome at 3 months following acute ischemic stroke. This suggests that NLR could be a useful and reliable prognostic biomarker following acute ischemic stroke.

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Increased Neutrophil-to-Lymphocyte Ratio is Associated with Unfavorable Functional Outcome in Acute Ischemic Stroke

Neurocritical Care ◽

10.1007/s12028-019-00859-5 ◽

2019 ◽

Vol 33 (1) ◽

pp. 97-104 ◽

Cited By ~ 4

Author(s):

Antje Giede-Jeppe ◽

Dominik Madžar ◽

Jochen A. Sembill ◽

Maximilian I. Sprügel ◽

Selim Atay ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

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Association between low-density cholesterol change and outcomes in acute ischemic stroke patients who underwent reperfusion therapy

BMC Neurology ◽

10.1186/s12883-021-02387-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ting Cui ◽

Changyi Wang ◽

Qiange Zhu ◽

Anmo Wang ◽

Xuening Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Reperfusion Therapy ◽

Low Density ◽

Poor Functional Outcome ◽

Lower Tertile

Abstract Background Low-density lipoprotein cholesterol (LDL-C) can increase cardiovascular risk. However, the association between LDL-C change and functional outcomes in acute ischemic stroke (AIS) patients who underwent reperfusion therapy remains unclear. Methods Patients who received reperfusion therapy were consecutively enrolled. LDL-C measurement was conducted at the emergency department immediately after admission and during hospitalization. The change of LDL-C level (ΔLDL-C) was calculated by subtracting the lowest LDL-C among all measurements during hospitalization from the admission LDL-C. Poor functional outcome was defined as modified Rankin Scale (mRS) > 2 at 90 days. Results A total of 432 patients were enrolled (mean age 69.2 ± 13.5 years, 54.6 % males). The mean LDL-C level at admission was 2.55 ± 0.93 mmol/L. The median ΔLDL-C level was 0.43 mmol/L (IQR 0.08–0.94 mmol/L). A total of 263 (60.9 %) patients had poor functional outcomes at 90 days. There was no significant association between admission LDL-C level and functional outcome (OR 0.99, 95 % CI 0.77–1.27, p = 0.904). ΔLDL-C level was positively associated with poor functional outcome (OR 1.80, 95 % CI 1,12-2.91, p = 0.016). When patients were divided into tertiles according to ΔLDL-C, those in the upper tertile (T3, 0.80–3.98 mmol/L) were positively associated with poor functional outcomes compared to patients in the lower tertile (T1, -0.91-0.13 mmol/L) (OR 2.56, 95 % CI 1.22–5.36, p = 0.013). The risk of poor functional outcome increased significantly with ΔLDL-C tertile (P-trend = 0.010). Conclusions In AIS patients who underwent reperfusion therapy, the decrease in LDL-C level during hospitalization was significantly associated with poor functional outcomes at 90 days.

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Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Stroke Severity and Short-Term Prognosis in Acute Ischemic Stroke With Intracranial Atherosclerotic Stenosis

Frontiers in Neurology ◽

10.3389/fneur.2021.705949 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yuanlin Ying ◽

Fang Yu ◽

Yunfang Luo ◽

Xianjing Feng ◽

Di Liao ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Neutrophil To Lymphocyte Ratio ◽

Stroke Severity ◽

Short Term ◽

Severe Stroke ◽

Lymphocyte Ratio ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis

Background: Neutrophil-to-lymphocyte ratio (NLR) is an indicator of poor prognosis in acute ischemic stroke (AIS), but associations between NLR with stroke severity and prognosis of intracranial atherosclerotic stenosis (ICAS)-related ischemic events have not been well-elucidated; therefore, we aimed to evaluate whether admission NLR levels correlate with the early stroke severity and short-term functional prognosis in patients with symptomatic intracranial atherosclerotic stenosis (sICAS).Methods: This retrospective study enrolled 899 consecutive patients with AIS attributed to ICAS at Xiangya Hospital stroke center between May 2016 and September 2020. The initial stroke severity was rated by the admission National Institutes of Health Stroke Scale (NIHSS) scores, and the short-term prognosis was evaluated using the 14-day modified Rankin Scale (mRS) scores after stroke onset. A severe stroke was defined as NIHSS >8; an unfavorable functional outcome was defined as mRS scores of 3–6. Admission NLR was determined based on circulating neutrophil and lymphocyte counts.Results: The median admission NLR of all patients was 2.80 [interquartile range (IQR), 2.00–4.00]. In univariate analysis, admission NLR was significantly elevated in patients with severe stroke and poor short-term prognosis. After multivariate adjustment, admission NLR levels were significantly correlated with severe stroke [odds ratio (OR), 1.132; 95% confidence interval (95% CI), 1.038–1.234; P = 0.005] and unfavorable short-term prognosis (OR, 1.102; 95% CI, 1.017–1.195; P = 0.018) in Model 1. In Model 2, the highest NLR tertile (≥3.533) remained an independent predictor of severe stroke (OR, 2.736; 95% CI, 1.590–4.708; P < 0.001) and unfavorable functional outcome (OR, 2.165; 95% CI, 1.416–3.311; P < 0.001) compared with the lowest NLR tertile (<2.231). The receiver operating characteristic (ROC) curves showed the predictability of NLR regarding the stroke severity [area under the curve (AUC), 0.659; 95% CI, 0.615–0.703; P < 0.001] and short-term prognosis (AUC, 0.613; 95% CI, 0.575–0.650; P < 0.001). The nomograms were constructed to create the predictive models of the severity and short-term outcome of sICAS.Conclusions: Elevated admission NLR levels were independently associated with the initial stroke severity and could be an early predictor of severity and poor short-term prognosis in AIS patients with ICAS, which might help us identify a target group timely for preventive therapies.

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