scholarly journals Neutrophil-to-Lymphocyte Ratio and Symptomatic Hemorrhagic Transformation in Ischemic Stroke Patients Undergoing Revascularization

2020 ◽  
Vol 10 (11) ◽  
pp. 771
Author(s):  
Milena Świtońska ◽  
Natalia Piekuś-Słomka ◽  
Artur Słomka ◽  
Paweł Sokal ◽  
Ewa Żekanowska ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Neutrophil To Lymphocyte Ratio ◽  
Study Endpoint ◽  
Stroke Treatment ◽  
Lymphocyte Ratio ◽  
Increased Risk

Objectives: Symptomatic hemorrhagic transformation (sHT) is a life-threatening complication of acute ischemic stroke (AIS). The early identification of the patients at increased risk of sHT can have clinically relevant implications. The aim of this study was to explore the validity and accuracy of the neutrophil-to-lymphocyte ratio (NLR) in predicting sHT in patients with AIS undergoing revascularization. Methods: Consecutive patients hospitalized for AIS who underwent intravenous thrombolysis, mechanical thrombectomy or both were identified. The NLR values were estimated at admission. The study endpoint was the occurrence of sHT within 24 h from stroke treatment. Results: Fifty-one patients with AIS were included, with a median age of 67 (interquartile range, 55–78) years. sHT occurred in 10 (19.6%) patients. Patients who developed sHT had higher NLR at admission. NLR was an independent predictor of sHT and showed good discriminatory power (area under the curve 0.81). In a multivariable analysis, NLR and systolic blood pressure were independently associated with sHT. Conclusions: NLR at admission can accurately predict sHT in patients with AIS undergoing revascularization.

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 Prognostic value of the neutrophil-to-lymphocyte ratio in acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chengbing Wang ◽  
Qian Zhang ◽  
Mingwei Ji ◽  
Jing Mang ◽  
Zhongxin Xu
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Poor Prognosis ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Increased Risk ◽  
The Relationship

Abstract Background The relationship between the neutrophil-to-lymphocyte ratio (NLR) and poor prognostics in acute ischemic stroke (AIS) patients who receive intravenous thrombolysis (IVT) remains controversial. The purpose of this systematic review and meta-analysis was to evaluate the association between the NLR and poor prognosis after IVT. Furthermore, we aimed to determine whether the NLR at admission or post-IVT plays a role in AIS patients who received IVT. Methods The PubMed, Embase, Web of Science and China National Knowledge Infrastructure databases were searched for relevant articles until October 7, 2020. Cohort and case-control studies were included if they were related to the 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 NLRs were associated with an increased risk of hemorrhagic transformation (HT) (OR = 1.33, 95 % CI = 1.14–1.56, P < 0.001) and a poor 3-month functional outcome (OR = 1.64, 95 % CI = 1.38–1.94, P < 0.001) in AIS patients who received IVT. Subgroup analysis suggested that the NLR at admission rather than post-IVT was associated with a higher risk of HT (OR = 1.33, 95 % CI = 1.01–1.75, P = 0.039). There was no statistically significant difference between higher NLRs and 3-month mortality (OR = 1.14, 95 % CI = 0.97–1.35, P = 0.120). Conclusions A high NLR can predict HT and poor 3-month functional outcomes in AIS patients who receive IVT. The NLR at admission rather than the post-IVT NLR was an independent risk factor for an increased risk of HT after IVT.

Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Eva Mistry ◽  
Adam H De Havenon ◽  
Christopher Leon Guerrero ◽  
Amre Nouh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Increased Risk ◽  
Significant Difference

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

scholarly journals Functional Outcome of Hemorrhagic Transformation after Thrombolysis for Ischemic Stroke: A Prospective Study

2015 ◽  
Vol 5 (3) ◽  
pp. 103-106 ◽  
Author(s):  
Mariam Annan ◽  
Marie Gaudron ◽  
Jean-Philippe Cottier ◽  
Xavier Cazals ◽  
Maelle Dejobert ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
University Hospital ◽  
3 Tesla ◽  
Stroke Severity ◽  
Increased Risk ◽  
3 Tesla Mri

Background/Aims: Hemorrhagic transformation (HT) is usually taken into account when symptomatic, but the role of asymptomatic HT is not well known. The aim of our study was to evaluate the link between HT after thrombolysis for ischemic stroke and functional outcome at 3 months, with particular emphasis on asymptomatic HT. Methods: Our study was performed prospectively between June 2012 and June 2013 in the Stroke Unit of the University Hospital Center of Tours (France). All patients treated with intravenous thrombolysis were consecutively included. HT was classified on susceptibility-weighted imaging (SWI) with 3-tesla MRI at 7 ± 3 days after treatment. We evaluated functional outcome at 3 months using the modified Rankin Scale (mRS). Dependency was defined as an mRS score of ≥3. Results: After 1 year, 128 patients had received thrombolytic therapy for ischemic stroke, of whom 90 patients underwent both 3-tesla MRI and SWI at day 7. Fifty-two had HT, including 8 symptomatic cases. At 3 months, 68% of those patients were dependent compared to 31% of patients without HT [OR 4.6 (1.9-11.4), p = 0.001]. In asymptomatic HT, the rate was 62% [OR 3.5 (1.4-8.9), p = 0.007], but did not reach significance after adjustment for stroke severity. Discussion: Our study found no statistically significant effect of HT on outcome after adjustment for initial stroke severity. However, the innocuousness of HT is not certain, and only few studies have already highlighted the increased risk of dependency. Using 3-tesla MRI with SWI allows us to increase the detection rate of small hemorrhage. Conclusion: HT after thrombolysis is very frequent on SWI, but the initial stroke severity is an important predictor to assess the role of HT for patient outcome.

scholarly journals Neutrophil-to-lymphocyte Ratio as a Risk Determinant of Hemorrhage Transformation in Acute Ischemic Stroke

2020 ◽  
pp. 8-16
Author(s):  
Shuang Ma ◽  
Bilal Muhammad ◽  
Shu Kan ◽  
Zhen-Ying Shang ◽  
Li Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Hemorrhagic Transformation ◽  
Neutrophil To Lymphocyte Ratio ◽  
Optimal Cutoff ◽  
Ischemic Lesion ◽  
Lymphocyte Ratio ◽  
Independent Risk Factors

Objective: The purpose of this study was to investigate the clinical significance between neutrophil-to-lymphocyte ratio (NLR) and classification of non-thrombolytic hemorrhagic transformation (HT) in acute ischemic stroke (AIS), to unravel new diagnostic approach. Methods: We recruited and selected 636 patients who did not undergo thrombolytic therapy between May 2018 and April 2019 at the Affiliated Hospital of Xuzhou Medical University. The laboratory and clinical data were collected within 24 h after the onset of AIS. Based on the status of HT development during hospitalization, all participants were divided into three groups, namely, the non-HT (NHT) group, hemorrhagic infarction (HI) group, and parenchymal hematoma (PH) group. Results: Multivariate logistic regression analysis showed that NLR and the ischemic lesion diameter are independent risk factors of HI and PH, while the score of National Institutes of Health Stroke Scale (NIHSS) and cardioembolism are considered to be independent risk factors for PH only. Receiver operating characteristic (ROC) analysis determined that the optimal cutoff values of NLR in HI group and PH group were 3.75 and 3.97, respectively. The optimal cutoff value can be used as the critical value for the unfavorable outcome. Conclusion: NLR values were significantly increased and correlated with both HI and PH groups and NLR could be used as a predictor of both HI and PH.

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