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Zhao Y, Wang X, Qin W, Shi S, Wang M, Zhang J, Zou X, Xu J, Li J, Shi X. Risk Warning of Neutrophil-to-Lymphocyte Ratio for Neurological Recovery in Acute Ischemic Stroke After Thrombolysis: A Retrospective Study. Brain Behav 2025; 15:e70373. [PMID: 40022214 PMCID: PMC11870821 DOI: 10.1002/brb3.70373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 01/31/2025] [Accepted: 02/06/2025] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND To investigate the relationship between dynamic changes in the neutrophil-to-lymphocyte ratio (NLR) and neurological recovery in noninfected patients with acute cerebral infarction after thrombolysis. METHODS A retrospective analysis was conducted on 277 patients with stroke thrombolysis. Least absolute shrinkage and selection operator (LASSO) regression was used to identify factors influencing recovery, and 1:1 propensity matching was performed between the groups to compare the changes in the National Institutes of Health Stroke Scale (NIHSS) score, muscle strength, and NLR after treatment. The receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR reduction after treatment, which serves as a diagnostic criterion for neurologic recovery. The posttreatment NLR reduction values were categorized according to whether they were equal to and greater than the cutoff value. Logistic regression was performed after intergroup matching to analyze the relationship between NLR and NIHSS. RESULTS The LASSO regression suggests that increased disease duration and atrial fibrillation are risk factors for neurologic recovery, whereas prolonged treatment duration and increased NLR reduction value are protective factors. Compared with the low-efficacy group, the high-efficacy group exhibited significantly lower NIHSS scores, NLR, and upper and lower extremity muscle strength scores after treatment (p < 0.05). The NLR reduction value was positively correlated with the NIHSS score reduction value and the change in the NIHSS score reduction rate (p < 0.001). The ROC curve and logistic regression indicated that patients with an NLR reduction value of ≥ 0.335 had good recovery. CONCLUSIONS Higher NLR reduction values indicate an improved neurologic prognosis after treatment. TRIAL REGISTRATION Clinical Retrospectively Registered Trials: ChiCTR2100045415.
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Affiliation(s)
- Yiran Zhao
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Xu Wang
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Wenxiu Qin
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Shaojing Shi
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Min Wang
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Jinsheng Zhang
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Xin Zou
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Junfeng Xu
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Jing Li
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
| | - Xuemin Shi
- Department of Acupuncture and MoxibustionFirst Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
- Department of Acupuncture and MoxibustionNational Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjinChina
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Cong Y, Xia X, Liao J, Zhang A, Zhang T, Cao X, Liu P, Ma F, Tang X, Chen J, Han Y, Chen Z, Li W, Zhu Y, Yao B, Wu M. Association of Systemic Inflammatory Response Index and Neutrophil-to-Lymphocyte Ratio on Unfavorable Functional Outcomes in Acute Ischemic Stroke Patients After Endovascular Therapy. World Neurosurg 2024; 190:e1071-e1080. [PMID: 39151692 DOI: 10.1016/j.wneu.2024.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Inflammatory markers for the prognosis of acute ischemic stroke (AIS) with endovascular therapy remain unclear. The purpose of this study was to investigate the association between the systemic inflammatory response index (SIRI) and neutrophil-to-lymphocyte ratio (NLR) with unfavorable functional outcomes at 90-day in individuals of AIS who underwent endovascular therapy. METHODS A total of 128 AIS patients who had endovascular therapy were enrolled from the Nanjing Stroke Registry between September 2019 and November 2022. Peripheral venous blood was collected from patients within 24 h of admission for information on the following parameters: neutrophil count, lymphocyte count, and monocyte count. Then, the SIRI and NLR values were calculated and the association among SIRI, NLR, and modifled Rankin Scale scores 90 days after endovascular therapy was examined via univariate and multivariate logistic analyses. Receiver operating characteristic curves were utilized to determine the best threshold for SIRI and NLR in predicting negative neurological outcomes following endovascular treatment for patients with AIS. RESULTS A total of 128 participants were evaluated, among which 50% had unfavorable outcomes. Linear regression analysis showed that the best threshold for SIRI was >1.407 (odds ratio = 1.265; 95% confidence interval, 1.071-1.493; P = 0.006), and for NLR it was >5.347 (odds ratio = 1.088; 95% confidence interval, 1.007-1.175; P = 0.033). These results revealed NLR and SIRI as significant predictors of unfavorable outcomes at 90 days. The area under the curve for SIRI and NLR in predicting 90-day adverse outcomes was 0.643 and 0.609, respectively. CONCLUSIONS Higher SIRI and NLR levels at admission may lead to unfavorable outcomes at 90 days for AIS patients with endovascular therapy.
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Affiliation(s)
- Yujun Cong
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Rushan Hospital of Traditional Chinese Medicine, Weihai, China
| | - Xin Xia
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Rugao Boai hospital, Nantong, China
| | - Junqi Liao
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Aimei Zhang
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Tianrui Zhang
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaofeng Cao
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Peian Liu
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Fei Ma
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaogang Tang
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jingyi Chen
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yang Han
- Department of Neurology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Zhaoyao Chen
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenlei Li
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuan Zhu
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Beibei Yao
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Minghua Wu
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China; The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
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Chaiwisitkun A, Muengtaweepongsa S. Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis. World J Exp Med 2024; 14:95540. [PMID: 39312695 PMCID: PMC11372743 DOI: 10.5493/wjem.v14.i3.95540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/22/2024] [Accepted: 06/12/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) retains a notable stance in global disease burden, with thrombolysis via recombinant tissue plasminogen activator (rtPA) serving as a viable management approach, albeit with variable outcomes and the potential for complications like hemorrhagic transformation (HT). The platelet-to-neutrophil ratio (P/NR) has been considered for its potential prognostic value in AIS, yet its capacity to predict outcomes following rtPA administration demands further exploration. AIM To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients. METHODS Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed. The relationship between P/NR and clinical outcomes [early neurological deterioration (E-ND), HT, delayed ND (D-ND), and 3-mo outcomes] was scrutinized. RESULTS Notable variables, such as age, diabetes, and stroke history, exhibited statistical disparities when comparing patients with and without E-ND, HT, D-ND, and 3-mo outcomes. P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3% sensitivity and a 52.5% specificity for 90-d outcomes. P/NR prognostic accuracy was statistically significant for 90-d outcomes [area under the curve (AUC) = 0.562], D-ND (AUC = 0.584), and HT (AUC = 0.607). CONCLUSION P/NR demonstrated an association with adverse 3-mo clinical outcomes, HT, and D-ND in AIS patients post-rtPA administration, indicating its potential as a predictive tool for complications and prognoses. This infers that a diminished P/NR may serve as a novel prognostic indicator, assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.
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Affiliation(s)
- Ausanee Chaiwisitkun
- Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Klonglaung 12120, Pathum Thani, Thailand
| | - Sombat Muengtaweepongsa
- Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Klonglaung 12120, Pathum Thani, Thailand
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Jiang F, Li J, Yu S, Miao J, Wang W, Xi X. Body fluids biomarkers associated with prognosis of acute ischemic stroke: progress and prospects. Future Sci OA 2024; 10:FSO931. [PMID: 38817358 PMCID: PMC11137785 DOI: 10.2144/fsoa-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/27/2023] [Indexed: 06/01/2024] Open
Abstract
Acute ischemic stroke (AIS) is one of the most common strokes posing a grave threat to human life and health. Predicting the prognosis of AIS allows for an understanding of disease progress, and a better quality of life by making individualized treatment scheme. In this paper, we conducted a systematic search on PubMed, focusing on the relevant literature in the last 5 years. Summarizing the candidate prognostic biomarkers of AIS in body fluids such as blood, urine, saliva and cerebrospinal fluid is often of great significance for the management of acute ischemic stroke, which has the potential to facilitate early diagnosis, treatment, prevention and long-term outcome improvement.
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Affiliation(s)
- Fengmang Jiang
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Junhua Li
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Simin Yu
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Jinli Miao
- Biological Medicine Research & Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, PR China
| | - Wenmin Wang
- Biological Medicine Research & Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, PR China
| | - Xiaohong Xi
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
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Zhang P, Xu P, Duan Z, Zhang F, Fang Y, Yan D, Zhang H, Cai Q, Huang X, Huang Z, Gu M, Xiao L, Wang J, Sun W. Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry. J Neurointerv Surg 2023; 15:e270-e276. [PMID: 36418161 DOI: 10.1136/jnis-2022-019437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few studies have focused on the effect of systemic inflammation in vertebrobasilar artery occlusion (VBAO). The aim of this study was to investigate the relationship between inflammatory indicators and the prognosis of VBAO patients receiving endovascular treatment (EVT). METHOD Patients with VBAO who were treated with EVT within 24 hours of the estimated occlusion time were included in this study. Multivariate logistic regression and elastic net regularization were performed to analyze the effects of inflammatory indicators on the prognosis of patients with VBAO. The primary outcome was unfavorable outcome (a modified Rankin Scale score of 4-6) at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage, in-hospital mortality, 90 day mortality, 1 year unfavorable outcome, and mortality. RESULTS 560 patients were included in the study. Multivariate analysis showed that white blood cells (W), neutrophils (N), neutrophil to lymphocyte ratio (NLR), platelet to neutrophil ratio, platelet to white blood cell ratio, and NLR to platelet ratio were associated with the primary outcome. Elastic net regularization indicated that W, N, and NLR were the major inflammatory predictors of unfavorable outcome at 90 days. For long term prognosis, we found that the inflammatory indicators that predicted 1 year outcomes were consistent with those that predicted 90 day outcomes. CONCLUSION Inflammatory indicators, especially W, N, and NLR, were associated with moderate and long term prognosis of patients with VBAO treated with EVT.
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Affiliation(s)
- Pan Zhang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Pengfei Xu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zuowei Duan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feng Zhang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yirong Fang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dingyi Yan
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hanhong Zhang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Qiankun Cai
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Zhixin Huang
- Department of Neurology, Guangdong Second Provincial General Hospita, Guangzhou, China
| | - Mengmeng Gu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinjing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wen Sun
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Zhou Y, Luo Y, Liang H, Zhong P, Wu D. Applicability of the low-grade inflammation score in predicting 90-day functional outcomes after acute ischemic stroke. BMC Neurol 2023; 23:320. [PMID: 37679730 PMCID: PMC10483771 DOI: 10.1186/s12883-023-03365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND AND PURPOSE The low-grade inflammation (LGI) score, a novel indicator of chronic LGI, combines C-reactive protein (CRP), leukocyte counts, the neutrophil/lymphocyte ratio (NLR), and the platelet (PLT) count to predict outcomes of patients with various conditions, such as cardiovascular diseases, cancers, and neurodegenerative diseases. However, few studies have examined the role of the LGI score in predicting functional outcomes of patients with ischemic stroke. The present study aimed to evaluate the association between the LGI score and functional outcomes of patients with ischemic stroke. METHODS A total of 1,215 patients were screened in the present study, and 876 patients were finally included in this retrospective observational study based on the inclusion and exclusion criteria. Blood tests were conducted within 24 h of admission. Severity of ischemic stroke was assessed using the NIHSS score with severe stroke denoted by NIHSS > 5. Early neurological deterioration (END) was defined as an increment in the total NIHSS score of ≥ 2 points within 7 days after admission. Patient outcomes were assessed on day 90 after stroke onset using the modified Rankin Scale (mRS). RESULTS The LGI score was positively correlated with baseline and the day 7 NIHSS scores (R2 = 0.119, p < 0.001;R2 = 0.123, p < 0.001). Multivariate regression analysis showed that the LGI score was an independent predictor of stroke severity and END. In the crude model, the LGI score in the fourth quartile was associated with a higher risk of poor outcomes on day 90 compared with the LGI score in the first quartile (OR = 5.02, 95% CI: 3.09-8.14, p for trend < 0.001). After adjusting for potential confounders, the LGI score in the fourth quartile was independently associated with poor outcomes on day 90 (OR = 2.65, 95% CI: 1.47-4.76, p for trend = 0.001). Finally, the ROC curve analysis showed an AUC of 0.682 for poor outcomes on day 90 after stroke onset. CONCLUSION The LGI score is strongly correlated with the severity of acute ischemic stroke and that the LGI score might be a good predictor for poor outcomes on day 90 in patients with acute ischemic stroke.
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Affiliation(s)
- Yang Zhou
- Emergency Department, Shaoxing People's Hospital, Shaoxing, Zhejiang Province, China
| | - Yufan Luo
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqing Road, Minhang District, Shanghai, 200240, China
| | - Huazheng Liang
- Monash Suzhou Research Institute, Suzhou Industrial Park, Suzhou, Jiangsu Province, China
| | - Ping Zhong
- Department of Neurology, Shanghai Yangpu District Shidong Hospital, 999 Shiguang Road, Yangpu District, Shanghai, 200438, China.
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqing Road, Minhang District, Shanghai, 200240, China.
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Wu B, Liu F, Sun G, Wang S. Prognostic role of dynamic neutrophil-to-lymphocyte ratio in acute ischemic stroke after reperfusion therapy: A meta-analysis. Front Neurol 2023; 14:1118563. [PMID: 36873451 PMCID: PMC9978711 DOI: 10.3389/fneur.2023.1118563] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Background The prognostic role of the neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, in acute ischemic stroke (AIS) after reperfusion therapy remains controversial. Therefore, this meta-analysis sought to assess the correlation between the dynamic NLR and the clinical outcomes of patients with AIS after reperfusion therapy. Methods PubMed, Web of Science, and Embase databases were searched to identify relevant literature from their inception to 27 October 2022. The clinical outcomes of interest included poor functional outcome (PFO) at 3 months, symptomatic intracerebral hemorrhage (sICH), and 3-month mortality. The NLR on admission (pre-treatment) and post-treatment was collected. The PFO was defined as a modified Rankin scale (mRS) of >2. Results A total of 17,232 patients in 52 studies were included in the meta-analysis. The admission NLR was higher in the 3-month PFO (standardized mean difference [SMD] = 0.46, 95% confidence interval [CI] = 0.35-0.57), sICH (SMD = 0.57, 95% CI = 0.30-0.85), and mortality at 3 months (SMD = 0.60, 95% CI = 0.34-0.87). An elevated admission NLR was associated with an increased risk of 3-month PFO (odds ratio [OR] = 1.13, 95% CI = 1.09-1.17), sICH (OR = 1.11, 95% CI = 1.06-1.16), and mortality at 3 months (OR = 1.13, 95% CI = 1.07-1.20). The post-treatment NLR was significantly higher in the 3-month PFO (SMD = 0.80, 95% CI = 0.62-0.99), sICH (SMD = 1.54, 95% CI = 0.97-2.10), and mortality at 3 months (SMD = 1.00, 95% CI = 0.31-1.69). An elevated post-treatment NLR was significantly associated with an increased risk of 3-month PFO (OR = 1.25, 95% CI = 1.16-1.35), sICH (OR = 1.14, 95% CI = 1.01-1.29), and mortality at 3 months (OR = 1.28, 95% CI = 1.09-1.50). Conclusion The admission and post-treatment NLR can be used as cost-effective and easily available biomarkers to predict the 3-month PFO, sICH, and mortality at 3 months in patients with AIS treated with reperfusion therapy. The post-treatment NLR provides better predictive power than the admission NLR. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022366394.
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Affiliation(s)
- Bing Wu
- Department of Neurology, Army 78th Military Group Hospital, Mudanjiang, China
| | - Fang Liu
- Department of Neurology, Army 78th Military Group Hospital, Mudanjiang, China
| | - Guiyan Sun
- Department of Neurology, Army 78th Military Group Hospital, Mudanjiang, China
| | - Shuang Wang
- Department of Neurology, Army 78th Military Group Hospital, Mudanjiang, China
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Shang T, Ma B, Shen Y, Wei C, Wang Z, Zhai W, Li M, Wang Y, Sun L. High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: A single-center retrospective study in China. Front Neurol 2022; 13:907486. [PMID: 36071906 PMCID: PMC9441903 DOI: 10.3389/fneur.2022.907486] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background and aims Recently, various hemocyte and blood cell ratios have garnered researchers' attention, as a low-cost, widely prevalent, and easy-to-measure index for diagnosing and predicting disease. Therefore, we sought to investigate the effect and predictive value of the peripheral blood neutrophil percentage and neutrophil-lymphocyte ratio (NLR) in the acute phase of ischemic stroke (AIS) in post-stroke cognitive impairment (PSCI). Methods We selected 454 patients with mild AIS and acquired general clinical data. The patients were divided into PSCI and post-stroke no cognitive impairment (PSNCI) groups according to their Montreal Cognitive Assessment (MOCA) scores. We assessed whether there were differences in clinical data, peripheral blood neutrophil percentage, and NLR values between the different groups. We also analyzed the independent influences on the occurrence of PSCI using a binary logistic regression. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the above inflammatory indicators and models containing different inflammatory indicators for PSCI. Results In total, 454 patients were included, of whom 253 (55.7%) patients were in the PSCI group, with a mean age of 62.15 ± 7.34 years and median neutrophil percentage and NLR of 0.64 (0.32–0.95) and 2.39 (0.71–54.46), respectively. Both neutrophil percentage (adjusted OR = 1.025; 95% confidence interval: 1.005–1.406) and NLR as a categorical variable (Q5, adjusted OR = 2.167; 95% CI: 1.127–4.166) were independent risk factors for PSCI, and the Q5 group (NLR ≥ 4.05) had significantly worse overall cognition and executive function. Conclusions Neutrophil percentage and NLR in the acute phase of AIS were independently associated with PSCI, and a high NLR was strongly associated with executive function. In addition, neutrophil percentage and NLR have diagnostic values for PSCI.
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Affiliation(s)
- Tianling Shang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Bo Ma
- Department of Hepatology, The First Hospital of Jilin University, Changchun, China
| | - Yanxin Shen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Chunxiao Wei
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zicheng Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weijie Zhai
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Mingxi Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yongchun Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li Sun
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Li Sun
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MM YL, Xu MM Q. Commentary: Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis. Front Physiol 2022; 13:936860. [PMID: 35784860 PMCID: PMC9240663 DOI: 10.3389/fphys.2022.936860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Qianghong Xu MM
- Department of Intensive Care, Zhejiang Hospital, Hangzhou, China
- *Correspondence: Qianghong Xu MM,
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