Abstract TMP62: Initial Neutrophil-Lymphocyte Ratio Predicts Ischemic Stroke Outcomes After Thrombolytic Therapy

Abstract

Introduction: Peripheral leukocyte counts and neutrophil-lymphocyte ratio (NLR) are readily available biomarkers that predict infarct size and mortality in acute ischemic stroke (AIS). Prognostic value of NLR in AIS patients treated with intravenous thrombolysis (IVT) remains to be determined. Methods: Data on consecutive AIS patients who received intravenous thrombolysis (IVT) was prospectively evaluated during a five-year period. NLR was determined within 12-hours of admission. Receiver operating characteristic and area under curve (AUC) values were used to obtain optimal NLR cutpoints, and predict functional outcomes: discharge disposition, functional independence (FI) [mRS 0-2], functional dependence (mRS 3-5), and mortality at discharge and 3 months. Results: Among 144 consecutive IVT-treated AIS patients, mean age was 70±13, 50% were female and median NIHSS was 12 [IQR 9-18]. In univariate analysis, lower NLR suggested association with FI (3.11±2.56 vs. 4.29±3.64, p=0.07). Optimal NLR cutpoints for FI and mortality were 3.6 (C-statistic [AUC] 0.63; 95CI 0.52-0.73) and 6.5 (C-statistic [AUC] 0.63; 95CI 0.45-0.82) respectively (Figure). In multivariate analysis after adjusting for age and NIHSS, NLR≤3.6 was a strong predictor for FI at discharge (OR: 4.1; 95CI 1.49-11.27; p=0.006), while NLR≥6.5 was an excellent predictor for mortality (OR 10.06; 95CI 2.51-40.31; p=0.001). Half of the patients with NLR≤3.6 were discharged home, in contrast to half with NLR≥6.5 discharged to either hospice or died (p=0.04). Conclusions: Initial NLR is a relevant biomarker for risk stratification and prediction of functional outcomes in AIS patients while evaluating for thrombolytic therapy. Elevated NLR likely reflects immune dysregulation and portends poor post-stroke outcomes.