Association of Early Longitudinal Changes in the Neutrophil-to-Lymphocyte Ratio With Adverse Clinical Outcomes in Acute Ischemic Stroke Patients After Endovascular Treatment

Abstract

Background and PurposeWe aim to elucidate the contribution of early dynamic changes in the neutrophil-to-lymphocyte ratio (NLR) to poor clinical outcomes in acute ischemic stroke (AIS) patients after endovascular treatment (EVT). MethodsAIS patients who underwent EVT were consecutively recruited from January 2019 to July 2022. Blood cell counts were sampled at admission and at following 24 hours after EVT. Clinical outcome measures included 3-month functional dependence (modified Rankin scale of 3-6), symptomatic intracranial hemorrhage (sICH), and mortality at seven days and 30 days. Multinomial logistic regressions were used to evaluate the association of changes in NLR with unfavorable outcomes. Results590 patients were included in the final analysis. The multinomial logistic model indicated that the increasing changes in NLR after EVT was an independent factor for poor outcomes; the adjusted odds ratio (aOR) was 1.06 (95% CI 1.03-1.10; P<0.001) at poor 3-month functional outcomes, 1.07 (95% CI 1.04-1.10; P<0.001) at sICH, 1.08 (95% CI 1.05-1.12; P<0.001) at mortality at seven days, and 1.04 (95% CI 1.02-1.07; P=0.001) at mortality at 30 days. Areas under the curve (AUC) of changes in NLR to discriminate adverse outcomes were 0.725, 0.687, 0.664, and 0.659. The optimal cut-off values were 5.77 (56.6 % sensitivity, 81.0% specificity), 6.92 (60.0% sensitivity, 77.0% specificity), 8.64 (51.0% sensitivity, 82.0% specificity), and 8.64 (48.7% sensitivity, 83.0% specificity), respectively. ConclusionsNLR in AIS patients increased remarkably independent of successful reperfusion. Elevated changes in NLR might predict malignant hemorrhagic transformation, adverse functional outcomes, and short-term mortality.