Abstract
Increasing evidence suggests that inflammation is associated with the development of acute ischemic stroke (AIS). The neutrophil-to-lymphocyte ratio (N/L) is an important marker of inflammation and is highly correlated with mortality in stroke patients in recent studies. The N/L of patients who experience hemorrhagic transformation (HT) after AIS is know, but any relationship between N/L and large artery atherosclerosis (LAA) remains unclear, this is our present topic. We enrolled 185 patients with LAA-type HT in the development cohort from a prospective, consecutive, hospital-based stroke registry to this end. We matched these patients to 213 LAA patients who did not develop HT as controls. The incidence of HT after LAA was significantly greater (P<0.01) in patients with higher N/L. We developed a predictive nomogram (incorporating age, systolic blood pressure, the National Institutes of Health Stroke Scale, and the N/L) for LAA patients. The predictive power was good (area under the curve, AUC: 0.832, 95%CI: 0.791–0.872). Our findings were further validated in a validation cohort of 202 patients with AIS attributable to LAA (AUC:0.836, 95%CI:0.781–0.891). In summary, a high N/L is associated with an increased risk for HT after LAA.
Highlights
Acute ischemic stroke (AIS) is the third leading cause of disability and death after cardiovascular disease and cancer [1]
Of the 398 patients in the development cohort, 185 developed hemorrhagic transformation (HT), and we matched them to 213 large artery atherosclerosis (LAA) patients without HT
Members of the HT group had an average age of 67.9 years, an average systolic blood pressure (SBP) of 150.4mmHg, an average of National Institute of Health Stroke Scale (NIHSS) of 6.6, and an average neutrophil-to-lymphocyte ratio (N/L) of 5.9; In the non-HT group, the average age was 63.7 years, the average SBP was 156.6mmHg, the average NIHSS was 2.4, and the average N/L was 2.7
Summary
Acute ischemic stroke (AIS) is the third leading cause of disability and death after cardiovascular disease and cancer [1]. The current gold standard treatment for AIS is reperfusion therapy, which includes intravenous administration of recombinant tissue plasminogen activator (rt-PA) and endovascular treatment [2]. Hemorrhagic transformation (HT) is the most serious complication of AIS, caused by either the natural evolution of diease or reperfusion therapy of AIS [3]. Current treatment guidelines recommend anticoagulants, thrombolysis, and intravascular procedures for AIS patients. Despite these suggestions, these treatments have not been fully utilized due to concerns about HT, in particular in China [4]. To determine whether thrombolytic therapy is safe, it is essential to understand why HT can develop after AIS
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