scholarly journals The Association of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio With Post-Thrombolysis Early Neurological Outcomes in Patients With Acute Ischemic Stroke

2020 ◽  
Author(s):  
Pengyu Gong ◽  
Yukai Liu ◽  
Yachi Gong ◽  
Gang Chen ◽  
Xiaohao Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Characteristic Curve ◽  
Intravenous Thrombolysis ◽  
Nihss Score ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Neurological Outcomes ◽  
Platelet Lymphocyte Ratio ◽  
Cell Counts

Abstract Background and Purpose: To investigate the association of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS).Methods: AIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as National Institutes of Health Stroke Scale (NIHSS) score increase of ≥4 within 24 hours after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥4 or complete recovery within 24 hours. Multivariable logistic regression analyses were performed to explore the relationship of NLR, PLR and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI.Results: Among 1060 recruited patients, a total of 193 (18.2%) were diagnosed with ENI and 398 (37.5%) were diagnosed with END. Multivariable logistic models indicated that NLR (odds ratio [OR], 1.652; 95% confidence interval [CI] 1.510-1.807, P=0.001) and PLR (OR, 1.015; 95% CI 1.012-1.018, P=0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.686; 95% CI 0.631-0.745, P=0.001), PLR (OR, 0.997; 95% CI 0.994-0.999, P=0.006) and LMR (OR, 1.170; 95% CI 1.043-1.313, P=0.008) served as independent factors for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR and LMR to discriminate END were 0.763, 0.703 and 0.551, respectively. AUC of NLR, PLR and LMR to discriminate ENI were 0.695, 0.530 and 0.547, respectively.Conclusions: NLR and PLR were associated with and may predict post-thrombolysis END. NLR, PLR and LMR were related to post-thrombolysis ENI.

scholarly journals The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Pengyu Gong ◽  
Yukai Liu ◽  
Yachi Gong ◽  
Gang Chen ◽  
Xiaohao Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multinomial Logistic Regression ◽  
Neutrophil To Lymphocyte Ratio ◽  
Platelet To Lymphocyte Ratio ◽  
Nihss Score ◽  
Lymphocyte Ratio ◽  
Neurological Outcomes ◽  
Lymphocyte To Monocyte Ratio ◽  
Cell Counts

Abstract Background and purpose To investigate the association of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS). Methods AIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as the National Institutes of Health Stroke Scale (NIHSS) score increase of ≥ 4 within 24 h after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥ 4 or complete recovery within 24 h. Multinomial logistic regression analysis was performed to explore the relationship of NLR, PLR, and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI. Results Among 1060 recruited patients, a total of 193 (18.2%) were diagnosed with END and 398 (37.5%) were diagnosed with ENI. Multinomial logistic model indicated that NLR (odds ratio [OR], 1.385; 95% confidence interval [CI] 1.238–1.551, P = 0.001), PLR (OR, 1.013; 95% CI 1.009–1.016, P = 0.001), and LMR (OR, 0.680; 95% CI 0.560–0.825, P = 0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.713; 95% CI 0.643–0.791, P = 0.001) served as an independent factor for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR, and LMR to discriminate END were 0.763, 0.703, and 0.551, respectively. AUC of NLR, PLR, and LMR to discriminate ENI were 0.695, 0.530, and 0.547, respectively. Conclusions NLR, PLR, and LMR were associated with post-thrombolysis END. NLR and PLR may predict post-thrombolysis END. NLR was related to post-thrombolysis ENI.

scholarly journals High Neutrophil-to-Lymphocyte Ratio Predicts Hemorrhagic Transformation in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Yong-Lin Liu ◽  
Jie-Kai Lu ◽  
Han-Peng Yin ◽  
Pei-Shan Xia ◽  
Dong-Hai Qiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Time ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Neutrophil To Lymphocyte Ratio ◽  
Nihss Score ◽  
Logistic Regression Models ◽  
Lymphocyte Ratio

Background. The relationship between the neutrophil-to-lymphocyte ratio (NLR) and hemorrhagic transformation (HT) in acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) remains unclear. This study assessed whether high NLR is associated with HT in this population. Methods. Data were prospectively collected for continuous patients with AIS treated with IVT and retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, onset-to-treatment time, and initial hematologic and neuroimaging findings. HT was confirmed by imaging performed within 3 days after IVT. Symptomatic HT (sHT) was defined as NIHSS score increased by 4 points compared with that on admission according to previously published criteria. The NLR value was based on the blood examination before IVT, and high NLR was defined as ≥75th percentile. Results. The study included 285 patients (201 (70.5%) males, the mean age was 62.3 years (range 29–89)). Seventy-two (25.3%) patients presented with HT, including three (1.1%) with sHT. The median NLR was 2.700 (1.820–4.255, interquartile range). Seventy-one (24.9%) patients had a high NLR (≥4.255) on admission. Univariate analysis indicated that patients with HT had higher NIHSS scores (P<0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P<0.05), as well as a greater prevalence of high NLR than those without HT (37.5% vs. 20.7% and P=0.004). Patients with HT were more likely to have hypertension and AF. As lymphocyte counts and high NLR were highly correlated, we used two logistic regression models. In model 1 (with high NLR), NIHSS score on admission (odds ratio (OR) = 1.110, 95% confidence interval (CI) = 1.015–1.044, and P=0.001), AF (OR = 3.986, 95% CI = 2.095–7.585, and P<0.001), and high NLR (OR = 2.078, 95% CI = 1.078–4.003, P=0.029, sensitivity 0.375, and specificity 0.793) were significant predictors of HT. In model 2 (with lymphocyte counts), NIHSS score on admission (OR = 1.111, 95% CI = 1.050–1.175, and P<0.001), AF (OR = 3.853, 95% CI = 2.048–7.248, and P<0.001), and lymphocyte counts (OR = 0.522, 95% CI = 0.333–0.819, and P=0.005) were significantly associated with HT. Conclusions. High NLR could be a useful marker for predicting HT in AIS patients after IVT.

scholarly journals Clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase)

2018 ◽  
Vol 5 (1) ◽  
pp. 164
Author(s):  
Shiva Prasad Jagini ◽  
Suresh I.
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Intravenous Thrombolysis ◽  
Clinical Profile ◽  
Favorable Outcome ◽  
Nihss Score ◽  
The Mean ◽  
Centre Hospital

Background: Stroke patients are at highest risk death in the first few weeks after the event, and between 20-50% die within first month depending on type, severity, age, co-morbidities and effectiveness of treatment of complications. Objective of this study was to clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase).Methods: Prospective Observational study of 26 cases of acute ischemic stroke receiving IV thrombolysis using rtPA-alteplase at Kovai Medical Centre Hospital, Coimbatore over a period of 1 year 9 months.Results: 21 cases had NIHSS score of range 10 to 22. The mean NIHSS score at admission is 13.5. 15 subjects (57.7%) had achieved primary outcome in this study. MRS Score of 0 to 2 is considered as favorable outcome. In this study 20 subjects (76.92 %) had favorable outcome at the end of 3 months.Conclusions: Majority of the patients receiving rtPA-alteplase had favorable outcome.

scholarly journals Comparison of Treatment Methods in the Management of Acute Ischemic Stroke.

2020 ◽  
Vol 7 (11) ◽  
pp. 5073-5079
Author(s):  
Ertugrul Altınbilek ◽  
Abdullah Algın ◽  
Mustafa Çalık ◽  
Ece Guven ◽  
Derya Ozturk ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Mortality Rates ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Tissue Destruction ◽  
Duration Of Treatment ◽  
Nihss Score

Aim: Acute ischemic stroke is an emergency clinical condition that occurs as a result of acute intracranial arterial occlusion and neural tissue destruction. In this study, we aimed to evaluate the treatment outcomes in patients who were performed intravenous thrombolysis (IVT), mechanical thrombectomy (MT), or both. Materials and Methods: In this retrospective study, 131 patients who underwent IVT, MT or both who has the diagnosis of AIS in our hospital between June 1, 2018, and February 1, 2018, were assessed. Age, sex, concomitant chronic diseases, NIHSS score, treatment-related complications, the time between disease presentation and hospital arrival, the duration of treatment, the one-month mortality rates and modified Rankin scores (MRS) were recorded. One-month mortality, NIHSS, and MRS were compared with treatment modalities and other factors. Results: The mean age of 131 patients included in the study was 71.79±12.67. The MRS did not differ significantly in the groups with IVT, MT, and IVT+MT (p> 0.05). In the IVT and MT groups, the NIHSS score increased significantly after the treatment (p <0.05). In the MT+IVT group, the NIHSS score after treatment did not change significantly (p> 0.05). Conclusion: No significant relationship between mortality rates and MRS with treatment method was found.  Complication rates were also not different among three treatment groups.

scholarly journals Prognostic factors of cerebral revascularisation in acute ischemic stroke at Hanoi Heart Hospital

2021 ◽  
Vol 35 ◽  
pp. 220-232
Author(s):  
Vu Quynh Nga ◽  
Tran Thanh Hoa ◽  
Pham Thi Hoa ◽  
Le Thi Thao
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Descriptive Analysis ◽  
Intravenous Thrombolysis ◽  
Severe Illness ◽  
Cross Sectional ◽  
Nihss Score ◽  
Mechanical Devices ◽  
Heart Hospital ◽  
Parenchymal Damage

Background: Considering the effectiveness of treatment for acute ischemic stroke (AIS)patients, the most expected method is immediate revascularization using intravenous thrombolysis or mechanical thrombectomy, or both methods. Objective: “Find factors related to post-treatment outcomes of acute ischemic stroke patients undergoing cerebral revascularization”. Method: Cross-sectional, prospective, descriptive analysis with convenient sample size. Results: From February 2018 to August 2021, 83 patients were hospitalized with a diagnosis of acute ischemic stroke or acute ischemic stroke and had cerebral revascularision either by thrombolysis or mechanical devices or both. 6.02% of them had cerebral thrombosis with mechanical devices and stenting of cerebral/carotid arteries. Mean age was 66.37±11.82 (range 31to 91 years). Mean NIHSS score was 12.57±6.70. The rate of complete recanalization was 91.56%. The mRS score of 0-2 points accounted for 48.19% at the time of discharge and 54.21% at 30 days after discharge. The rate of death or severe illness at discharge accounted for 14.45%. 30 days all-cause mortality after discharge accounted for 25.3%. Conclusion: The rate of complete reperfusion in patients with acute cerebral infarction at Hanoi Heart Hospital and good recovery rate is quite high. Factors that  related to the treatment efficacy of patients with acute ischemic stroke were NIHSS score, ASPECT score, occlusion site, pre-reperfusion parenchymal damage and the selection of appropriate reperfusion measures.

scholarly journals Tenecteplase versus alteplase for acute ischemic stroke thrombolysis: a systematic review and meta-analysis

2021 ◽  
Vol 26 (4) ◽  
pp. 671-683
Author(s):  
YinQin Hu ◽  
YangBo Hou ◽  
Zhen Chen ◽  
Qian Xiao ◽  
Huixia Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Cochrane Library ◽  
Nihss Score ◽  
Thrombolytic Drug ◽  
Symptomatic Intracranial Hemorrhage

Background: Intravenous thrombolysis is the preferred clinical treatment for acute ischemic stroke. Alteplase is an intravenous thrombolytic drug used in clinical practice. Recently, studies have shown the efficacy of another intravenous thrombolytic drug, tenecteplase, and have reported that the risk of bleeding is low. However, at present, Chinese and international research has yielded controversial results regarding the efficacy and risks of tenecteplase. Therefore, this systematic review and meta- analysis of the efficacy and safety of tenecteplase were performed. Methods: PubMed, the Cochrane Library, MEDLINE, the Wanfang Database and CNKI were searched for all studies on the thrombolytic treatment of acute ischemic stroke. All studies published in English prior to March 2021 were retrieved. The studies were screened and selected based on the inclusion and exclusion criteria. Then, the data were extracted and recorded by trained researchers. RevMan 5.4 statistical software was used to analyze the data on the 24h recanalization rate, early neurological improvement (24h reduction in the National Institutes of Health Stroke Scale [NIHSS] score of at least 8 points or 24 h NIHSS score of 0~1 point), mRS score at 90 days, intracranial hemorrhage, symptomatic intracranial hemorrhage and mortality in the tenecteplase group and alteplase group. Results: A total of 565 related studies were identified through the initial searches in each database. The citations of meta-analyses and related reviews were screened for additional eligible articles. Eventually, 9 high-quality English-language articles that included 2149 patients with acute ischemic stroke (including 1035 in the tenecteplase group and 1046 in the alteplase group)were included in this meta-analysis. The meta-analysis results were as follows: (1) Efficacy: The 24 h recanalization rate with regard to vascular recanalization was significantly better in the tenecteplase group than in the alteplase group(OR = 1.83, 95% CI: 1.23~2.72, z = 2.97, P = 0.003). There was significantly greater improvement in early neurological function in the tenecteplase group than in the alteplase group (OR= 1.34, 95% CI: 1.11~1.63, Z=3.00, P =0.003). There were no significant differences in 90-day mRS scores between the two groups (mRS score =0-1, OR = 1.20, 95% CI: 0.99~1.46, z = 1.82, p = 0.07; mRS score =0-2, OR = 1.17, 95% CI: 0.94~1.45, z = 1.38, p = 0.17). However, the subgroup analysis showed that the 90-day mRS score of the 0.25 mg/kg tenecteplase group was significantly different from that of groups treated with other doses of tenecteplase (OR = 1.48, 95% CI: 1.01~2.03, z = 2.03, p = 0.04). (2) Safety: The incidences of any intracranial hemorrhage (OR = 0.91, 95% Ci: 0.55~1.49, z = 0.39, p = 0.70), symptomatic intracranial hemorrhage (OR = 1.21, 95% CI: 0.63~2.32, z = 0.56 P = 0.57), and mortality (OR = 0.85, 95% CI: 0.57~1.26, z = 0.82, p = 0.41) were not significantly different between the tenecteplase and alteplase groups. Conclusions: Tenecteplase can significantly increase the 24-hour vascular recanalization rate and improve the neurological prognosis of patients with acute ischemic stroke and it does not increase the risk of intracranial hemorrhage or mortality.

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