scholarly journals High Platelet Lymphocyte Ratio as Predictor of Bad Outcome in Patient with Acute Ischemic Stroke

2021 ◽  
Vol 8 (10) ◽  
pp. 277-281
Author(s):  
Fani Nanda Sihanto ◽  
Mochamad Bahrudin ◽  
Suharto .
Keyword(s):  
Ischemic Stroke ◽  
Literature Review ◽  
Acute Ischemic Stroke ◽  
Thrombus Formation ◽  
Stroke Patients ◽  
Acute Ischemic Stroke Patient ◽  
Lymphocyte Ratio ◽  
Poor Outcome ◽  
Platelet Lymphocyte Ratio ◽  
Markers Of Inflammation

Background/Aim: Stroke is a major cause of death and disability worldwide. Inflammatory markers for poor outcomes in stroke patients have been widely studied, but these examinations are often constrained by limited costs and facilities. Platelet lymphocyte ratio is one of the markers of inflammation that is easily examined, only a few researches were studied on stroke patients, especially ischemic type. This article aimed to understanding high platelet lymphocyte ratio as a risk factor for poor outcome in acute ischemic stroke patients. Method: The design of this research is literature review by literature from 32 journal and 5 textbooks. Journals obtained from search engines Pubmed, Google Scholar, and NCBI. Result: Based on the results of the literature review, circulating platelets play an important role in the development and resolution, not only because of their direct effect on the endothelium but also by releasing inflammatory mediators. Acute ischemic stroke will induce lymphocyte apoptosis, which causes impaired immune system. High platelet counts and low lymphocytes contribute to micro-thrombus formation, which increases the risk of stroke and has a poor prognosis in patient. Conclusion: There is an increase platelet lymphocyte ratio can be an independent predictor of poor outcome in acute ischemic stroke patient Keywords: acute ischemic, stroke, platelet lymphocyte ratio, poor outcome

scholarly journals CORRELATION BETWEEN NEUTROPHIL-TO-LYMPHOCYTE RATIO AND HIGH SENSITIVITY C REACTIVE PROTEIN WITH SEVERITY AND OUTCOME IN ACUTE ISCHEMIC STROKE PATIENT

2020 ◽  
Vol 7 (8) ◽  
pp. 75-80
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
High Sensitivity ◽  
Neutrophil To Lymphocyte Ratio ◽  
C Reactive Protein ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Acute Ischemic Stroke Patient ◽  
Lymphocyte Ratio ◽  
Reactive Protein

Background: Inflammation plays a role in the pathophysiology of cerebral ischemic and also an initial response to brain injury. Inflammation involving Blood and Brain Barrier disturbance, leukocyte infiltration, endothelial cells activation, oxidant and inflammatory mediator buildups which can develop rapidly within hours and can cause secondary injury to brain tissues Objectives: To determine the correlation between Neutrophil-to-Lymphocyte Ratio (NLR) and High Sensitivity C Reactive Protein (hsCRP) with severity and outcome in acute ischemic stroke patients Methods: This study used a cross-sectional design approach. Sampling was done at H. Adam Malik General Hospital Medan and taken as many as 38 subjects. NLR and hsCRP were examined on the first day of admission. Severity was assessed by using the National Institutes of Health Stroke Scale and the outcome was assessed by using the Modified Ranking Scale on the first and fourteenth day of admission. The data analysis used the contingency coefficient correlation test and gamma test. Results: Demographic characteristics of the subjects are; the average age is 62 years old, the highest educational level is high school graduate, and the most occupation is unemployed. There is a positive, moderate, and significant correlation between NLR and severity of acute ischemic stroke (r=0.511; p=0.001). There is a positive, moderate, and significant correlation between NLR and the outcome of acute ischemic stroke (r=0.463; p=0.001). There is a positive, very strong, and significant correlation between hsCRP and severity of acute ischemic stroke (r=0.896; p=0.001). There is a positive, strong, and significant correlation between hsCRP and outcome of acute ischemic stroke (r=0.624; p=0.001) Conclusions: There is a positive and significant correlation between NLR and hsCRP with severity and outcome in acute ischemic stroke patients.

Abstract 10: Predictors of Poor Outcome in Acute Ischemic Stroke Patients after Successful Recanalization

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Amy K Starosciak ◽  
Italo Linfante ◽  
Gail Walker ◽  
Osama O Zaidat ◽  
Alicia C Castonguay ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Power ◽  
Rescue Therapy ◽  
Univariate Analysis ◽  
Stroke Patients ◽  
Good Outcome ◽  
Poor Outcome

Background: Recanalization of the occluded artery is a powerful predictor of good outcome in acute ischemic stroke secondary to large artery occlusions. Mechanical thrombectomy with stent-trievers results in higher recanalization rates and better outcomes compared to previous devices. However, despite successful recanalization rates (Treatment in Cerebral Infarction, TICI, score ≥ 2b) between 70 and 90%, good clinical outcomes assessed by modified Rankin Scale (mRS) ≤ 2 is present in 40-50% of patients . We aimed to evaluate predictors of poor outcomes (mRS > 2) despite successful recanalization (TICI ≥ 2b) in the acute stroke patients treated with the Solitaire device of the North American Solitaire Stent Retriever Acute Stroke (NASA) registry. Methods: The NASA registry is a multicenter, non-sponsored, physician-conducted, post-marketing registry on the use of SOLITAIRE FR device in 354 acute, large vessel, ischemic stroke patients. Logistic regression was used to evaluate patient characteristics and treatment parameters for association with 90-day mRS score of 0-2 (good outcome) versus 3-6 (poor outcome) within patients who were recanalized successfully (Thrombolysis in Cerebral Infarction or TICI score 2b-3). Univariate tests were followed by development of a multivariable model based on stepwise selection with entry and retention criteria of p < 0.05 from the set of factors with at least marginal significance (p ≤ 0.10) on univariate analysis. The c-statistic was calculated as a measure of predictive power. Results: Out of 354 patients, 256 (72.3%) were successfully recanalized (TICI ≥ 2b). Based on 90-day mRS score for 234 of these patients, there were 116 (49.6%) with mRS > 2. Univariate analysis identified increased risk of mRS > 2 for each of the following: age ≥ 80 years (upper quartile of data), occlusion site other than M1/M2, NIH Stroke Scale (NIHSS) score ≥ 18 (median), history of diabetes mellitus (DM), TICI = 2b, use of rescue therapy, not using a balloon-guided catheter (BGC) or intravenous tissue plasminogen activator (IV t-PA), and time to recanalization > 30 minutes (all p ≤ 0.05). Three or more passes was marginally significant (p=0.097). In multivariable analysis, age ≥ 80 years, site other than M1/M2, initial NIHSS ≥18, DM, absence of IV t-PA, use of rescue therapy and three or more passes were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index = 0.80). Conclusions: Age, occlusion site, high NIHSS, diabetes, not receiving IV t-PA, use of rescue therapy and three or more passes, were associated with poor 90-day outcome despite successful recanalization.

scholarly journals Correlation of neutrophil-to-lymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19

Narra J ◽  
2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Rizky Sarengat ◽  
Mohammad S. Islam ◽  
Mohammad S. Ardhi
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
National Institutes Of Health ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Lymphocyte Ratio ◽  
Life Threatening ◽  
The Mean

The coronavirus disease 2019 (COVID-19) pandemic has caused millions of deaths worldwide. Acute ischemic stroke is a life-threatening risk factor for COVID-19 infection. Neutrophil-to-lymphocyte ratio (NLR) is one of the predictors of poor prognosis in acute ischemic stroke. The aim of this study was to assess the correlation between NLR values and the clinical outcome of acute thrombotic stroke patients with COVID-19 that was measured using the National Institutes of Health Stroke Scale (NIHSS). A cross-sectional hospital-based study was conducted in Dr. Soetomo General Hospital Surabaya, Indonesia. Patients with acute thrombotic stroke and COVID-19 admitted between 1 March 2020 and 31 May 2021 were recruited. The NLR values and the NIHSS scores were assessed during the admission and the correlation between NLR and NIHSS scores was calculated. This study included 21 patients with acute thrombotic stroke and COVID-19, consisting of 12 males and 9 females. The mean age was 57.6 years old. The mean NLR values was 8.33±6.7 and the NIHSS scores ranging from 1 to 33. Our data suggested a positive correlation between NLR values and NIHSS scores, r=0.45 with p=0.041. In conclusion, the NLR value is potentially to be used as a predictor of the clinical outcome in acute thrombotic stroke patients with COVID-19. However, further study is warranted to validate this finding.

Defining Minor Symptoms in Acute Ischemic Stroke

2015 ◽  
Vol 39 (3-4) ◽  
pp. 209-215 ◽  
Author(s):  
Davide Strambo ◽  
Alberto A. Zambon ◽  
Luisa Roveri ◽  
Giacomo Giacalone ◽  
Giovanni Di Maggio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Motor Impairment ◽  
Epidemiological Data ◽  
Minor Stroke ◽  
Predictors Of Outcome ◽  
Stroke Patients ◽  
Nihss Score ◽  
Poor Outcome ◽  
Definition Of

Background: Thrombolysis is often withheld from acute ischemic stroke patients presenting with mild symptoms; however, up to 40% of these patients end up with a poor outcome when left untreated. Since there is lack of consensus on the definition of minor symptoms, we aimed at addressing this issue by looking for features that would better predict functional outcomes at 3 months. Methods: Among all acute ischemic stroke patients admitted to our Stroke Unit (n = 1,229), we selected a cohort of patients who arrived within 24 hours from symptoms onset, with baseline NIHSS ≤6, not treated with thrombolysis (n = 304). Epidemiological data, comorbidities, radiological features and clinical presentation (NIHSS items) were collected to identify predictors of outcome. Our cohort was tested against minor stroke definitions selected from the literature and a newly proposed one. Results: Three months after stroke onset, 97 patients (31.9%) had mRS ≥2. Independent predictors of poor outcome were age (OR 0.97 [95% CI 0.95-9.99]) and baseline NIHSS score (OR 0.79 [95% CI 0.67-0.94]), while cardioembolic aetiology was negatively associated (OR 3.29 [95% CI 1.51-7.14]). Items of NIHSS associated with poor outcome were impairment of right motor arm (OR 0.49 [95% CI 0.27-0.91]) or the involvement of any of the motor items (OR 0.69 [95% CI 0.48-0.99]). The definition of minor stroke as NIHSS ≤3 and the new proposed definition had the highest sensitivity and accuracy and were independent predictors of outcome. Conclusions: Our study confirmed that in spite of a low NIHSS score, one third of patients had poor outcome. As already described, age and NIHSS score remained independent predictors of poor outcome even in mild stroke. Also, motor impairment appeared a major determinant of poor outcome. The new proposed definition of minor stroke featured the NIHSS score and the NIHSS items that better predicted functional outcome. Awareness that even minor stroke can yield to poor outcome should sensitize patients to arrive early to the ED and neurologists to administer rt-PA.

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 PERBEDAAN LUARAN PASIEN STROKE ISKEMIK AKUT DENGAN LEUKOSIT NORMAL DAN LEUKOSITOSIS

2018 ◽  
Vol 36 (1) ◽  
Author(s):  
Clarissa Tertia ◽  
Belinda Orline Olivia Singgih ◽  
I Ketut Sumada ◽  
Ni Ketut Candra Wiratmi ◽  
Putu Eka Widyadharma
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Leukocyte Count ◽  
Clinical Manifestations ◽  
Acute Onset ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Chi Square ◽  
Acute Ischemic Stroke Patient ◽  
Normal Leukocyte

    DIFFERENCE IN OUTCOME OF ACUTE ISCHEMIC STROKE PATIENT WITH NORMAL LEUKOCYTE AND LEUKOCYTOSISABSTRACTIntroduction: Inflammation is an independent risk factor for ischemic stroke, which needs to be inhibited to reduce worsening occlusion of arteries due to atherosclerotic plaques. Increased leukocyte count is considered an acute damage marker of brain tissue that experiences ischemia and is used to determine the severity and prognosis of acute ischemic stroke.Aims: To analyse association between the number of leukocytes in acute onset ischemic stroke patients during admission and discharge.Methods: A prospective analytical observational study with a cohort design on acute ischemic stroke patients in Wangaya Regional Hospital, Denpasar-Bali between January and September 2018. Clinical manifestations were assessed using National Institutes of Health Stroke Scale (NIHSS). Data was collected through medical records and analysed using Chi-square test and Mann-Whitney.Results: Seventy-six subjects devided into 2 groups;  normal  leucocytes and  leucocytosis group,  38 patients respectively. The normal leucocytes group was dominated with male subject (78.9%) and mean leucocytes count was 7,612/mm3. While leucocytosis group was dominated with female subjects (63.2%) and mean leucocytes count was 12,294/ mm3. Mean NIHSS at admission in normal leucocytes group and leucocytosis group was 5 (moderate) and 8 (moderate) respectively. Mean NIHSS at discharge in normal leucocytes group and leucocytosis group was 3 (low) and 11 (moderate) respectively.Discussion: Patients with acute onset ischemic stroke with normal leukocyte count during admission, tend to have better clinical outcome two times fold compared to the patients with leucocytosis.Keywords: Leukocytes, leucocytosis, acute ischemic stroke, NIHSSABSTRAKPendahuluan: Inflamasi merupakan faktor risiko independen terjadinya stroke iskemik, yang perlu dihambat untuk mengurangi perburukan oklusi pada pembuluh darah akibat plak aterosklerotik. Peningkatan kadar leukosit dianggap menunjukkan kerusakan akut jaringan otak yang mengalami iskemia dan digunakan untuk mengetahui tingkat keparahan dan prognosis stroke iskemik akut.Tujuan Mengetahui hubungan antara kadar leukosit terhadap manifestasi klinis pasien stroke iskemik onset akut pada saat masuk dan keluar perawatan.Metode: Penelitian observasional analitik prospektif dengan rancangan kohort terhadap pasien stroke iskemik onset akut yang dirawat di RSUD Wangaya, Denpasar, pada bulan Januari hingga September 2018. Manifestasi klinis subjek dinilai berdasarkan derajat beratnya stroke menggunakan National Institutes of Health Stroke Scale (NIHSS). Data dikumpulkan melalui rekam medis dan di analisis dengan uji Chi-square dan Mann-Whitney.Hasil: Didapatkan 76 subjek yang dibagi menjadi 2 kelompok, yaitu masing-masing 38 subjek pada kelompok dengan leukosit normal dan kelompok dengan leukositosis. Kelompok subjek leukosit normal, didominasi oleh subjek laki- laki (78,9%) dan rerata kadar leukosit 7.612/mm3, sedangkan pada kelompok leukositosis mayoritas perempuan (63,2%) dan rerata kadar leukosit 12.294/mm3. Rerata skor NIHSS saat masuk pada kelompok leukosit normal adalah 5 (moderat) dan  pada kelompok dengan leukositosis adalah 8 (moderat). Adapun rerata skor NIHSS pada kelompok leukosit normal saat pasien keluar adalah 3 (ringan) dan 11 (moderat) pada kelompok leukositosis.Diskusi: Subjek stroke iskemik akut dengan kadar leukosit awal yang normal cenderung memiliki perbaikan manifestasi klinis pada saat keluar RS dua kali lebih baik daripada subjek dengan leukositosis.Kata kunci: Leukosit, leukositosis, stroke iskemik akut, skor NIHSS

Abstract T P308: Does Hospitalist Directed Care Reduce The Length Of Stay For Acute Ischemic Stroke Patients And Improve Adherence To The “Get With The Guidelines” Inpatient Quality Measures?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Christian Sanchez ◽  
Ahmed A Malik ◽  
Erlinda Abantao ◽  
Olive Sanchez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Family Practice ◽  
Quality Measures ◽  
Stroke Patients ◽  
Thromboembolism Prophylaxis ◽  
Acute Ischemic Stroke Patient ◽  
Significant Difference ◽  
Get With The Guidelines

Background: Hospitalist directed care has shown significant association with improved lengths of stay with improvements in outcomes in several acute conditions. The hospitalist effect has not been studied in acute ischemic stroke management. Objective: To identify acute ischemic stroke patients admitted under a hospitalist, internist, family practice physician, or a specialist and compare the length of stay, discharge outcome, and adherence to the “Get with the Guidelines” (GWTG) stroke performance measures prior to discharge. Methods: We identified consecutive acute ischemic stroke patients over a 4-year period (June 2010-June 2014) from a private Gold Plus Target Stroke Honor Roll primary stroke center. We categorized all stroke admissions according to admitting physicians - hospitalist, internist, family practice, or specialty physician directed care. We collected demographics, risk factors and discharge outcomes based on the modified Rankin Scale (mRS). We analyzed all of the GWTG stroke inpatient quality measures (venous thromboembolism prophylaxis, statin on discharge, anthithrombotic by end of day 2, antithrombotic medication on discharge, atrial fibrillation discharged on anticoagulant) and compared rate of deficiencies between the four groups of admitting physicians. Results: A total of 1584 patients [mean age (± SD) 68.6±13.7 years; 55.6% men] were admitted with acute ischemic stroke. There was no statistically significant difference in length of stay between the 4 groups (p=0.4). There was a significant difference in the GTWG inpatient quality measures with the hospitalist group having the lowest rates of deficiencies seen with 5% of their admissions (p=0.03), and the internists have the highest rate of deficiencies with 16% of their admissions (p=0.01). The most common deficiency was not prescribing a statin at discharge (56% of total fallouts). There was no difference in poor outcomes on discharge (mRS 3-6) (p=0.2). Conclusions: There is a significant improvement in adherence to the GWTG inpatient stroke measures when an acute ischemic stroke patient is admitted under the care of a hospitalist. Prospective databases are recommended to evaluate if this leads to better long term outcomes.

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