Abstract
Background The relationship between the neutrophil-to-lymphocyte ratio (NLR) and hemorrhagic transformation (HT) in acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) remains unclear. This study assessed whether high NLR is associated with HT in this population. Methods Data were prospectively collected for continuous patients with AIS treated with IVT and retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, onset-to-treatment time, and initial hematologic and neuroimaging findings. HT was confirmed by imaging performed within 3 days after IVT. Symptomatic HT (sHT) was defined as NIHSS score increased by 4 points compared with that on admission according to previously published criteria. The NLR value was based on the blood examination before IVT, and high NLR was defined as ≥75th percentile. Results The study included 285 patients (201 (70.5%) males, the mean age was 62.3 years (range 29–89)). Seventy-two (25.3%) patients presented with HT, including three (1.1%) with sHT. The median NLR was 2.700 (1.820–4.255, interquartile range). Seventy-one (24.9%) patients had a high NLR (≥4.255) on admission. Univariate analysis indicated that patients with HT had higher NIHSS scores (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P < 0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (Conclusions High NLR could be a useful marker for predicting HT in AIS patients after IVT.
Highlights
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (r-tPA) is an effective treatment for acute ischemic stroke (AIS) when administered within the hyperacute period [1, 2]
21 patients were excluded for the following reasons: additional endovascular therapy after IVT (n 2), permanent or temporary contraindication for magnetic resonance imaging (MRI) (n 3), and no acute lesion found on diffusion-weighted imaging (DWI) (n 16)
No remote Hemorrhagic transformation (HT) were found in our study. e mean onset-to-treatment time (OTT) was 200.4 ± 55.9 minutes, and the median National Institutes of Health Stroke Scale (NIHSS) score on admission was 7 (4–10, interquartile range (IQR)). e median neutrophil-to-lymphocyte ratio (NLR) was 2.700 (1.820–4.255, IQR)
Summary
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (r-tPA) is an effective treatment for acute ischemic stroke (AIS) when administered within the hyperacute period [1, 2]. IVT has been reported to increase the incidence of HT markedly [7]. International Journal of Hypertension [12], dual antiplatelet agent treatment before IVT [13], and systolic blood pressure variability [14] are the predictors of HT after IVT. Several studies reported that a high neutrophil-to-lymphocyte ratio (NLR) was predictive of HT in AIS patients [15, 16]. There were limited data on the relationship between NLR and HT in AIS patients treated with IVT. E present study was performed to assess whether high NLR is associated with HT in AIS patients after IVT There were limited data on the relationship between NLR and HT in AIS patients treated with IVT. e present study was performed to assess whether high NLR is associated with HT in AIS patients after IVT
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