Abstract
Background and PurposeMounting researches have illuminated that the neutrophil-related ratios were related to the prognosis of acute ischemic stroke (AIS). However, few have compared their predictive value and accuracy. To make such comparison and identify the best indicator on the 90-day outcome, we investigated biomarkers including neutrophil ratio (Nr), neutrophil count (Nc), lymphocyte (L), neutrophil-to-lymphocyte ratio (NLR), platelet (P or PLT), platelet-to-neutrophil ratio (PNR), NLR-to-platelet ratio (NLR/PLT), eosinophil (E), neutrophil-to-eosinophil ratio (NER), monocyte (M), and monocyte-to-neutrophil ratio (MNR).MethodsThis retrospective study recruited 283 AIS and 872 healthy controls (HCs) receiving intravenous thrombolysis (IVT). Blood samples were collected after 24 h of admission before IVT. Propensity Score Matching (PSM) was used to explore whether these ratios differentiated AIS and HCs. We applied univariate and multivariate analyses to evaluate the prediction effect of these ratios separately or added in the model and figured out a clinical prediction model. To estimate the discrimination and calibration of the new models, the receiver operating characteristics (ROC) curve analysis, DeLong method, and likelihood ratio test (LR test) were utilized.ResultsPSM showed that Nr, Nc, NLR, P, PNR, NLR/PLT, NER, and MNR facilitates the differentiation of the HCs and AIS. Among the eight biomarkers, PNR and MNR could differentiate the 90-day outcome, and it was found out that PNR performed better. Univariate regression analysis demonstrated that PNR was the only independent predictor which needs no adjustment. Besides, the multivariate regression analysis, Delong method, and LR test indicated that among the neutrophil-related ratios, NLR, PNR, NLR/PLT, NER, and MNR exerted little influence on the discrimination but could enhance the calibration of the base model, and NER proved to work best.ConclusionLow PNR was the best indicator among the neutrophil-related ratios tin predicting a poor 90-day outcome of AIS patients. Moreover, high NER performed best when predicting the 90-day outcome to improve the calibration of the base model.
Highlights
The world is facing an epidemic of stroke
Before PSM, a higher level of neutrophil count (Nc) and lower levels of L, P, and M led to higher neutrophil-to-lymphocyte ratio (NLR) levels [1.94 (1.44–3.11) vs. 1.44 (1.16–1.85); p < 0.001], lower platelet-to-neutrophil ratio (PNR) levels [46.00 (34.81–59.80) vs. 71.43 (57.65–87.98); p < 0.001], and lower monocyte-to-neutrophil ratio (MNR) levels [0.11 (0.08–0.14) vs. 0.13 (0.10–0.16); p < 0.001] in the Acute ischemic stroke (AIS) patients
Nc was the only component contributing to higher neutrophil-to-eosinophil ratio (NER) levels, since there was no statistical difference between the AIS patients and healthy controls (HCs) in E (0.15 ± 0.15 vs. 0.16 ± 0.15, p = 0.256)
Summary
The world is facing an epidemic of stroke. Despite the stable incidence rates and declining mortality rates, the past two decades has seen the number of incident strokes, prevalent stroke survivors, disability-adjusted life-years lost due to stroke, and stroke-related deaths increasing (Hankey, 2017). It is significant to find biomarkers that can predict the prognosis of AIS patients. Leukocytes and their subtypes, as the commonly used inflammatory markers in clinical practice, are considered to be associated with infarct volume, infarct severity, and adverse outcomes (Chen et al, 2017). Mounting researches have illuminated that the neutrophilrelated ratios were related to the prognosis of acute ischemic stroke (AIS). Few have compared their predictive value and accuracy To make such comparison and identify the best indicator on the 90-day outcome, we investigated biomarkers including neutrophil ratio (Nr), neutrophil count (Nc), lymphocyte (L), neutrophil-to-lymphocyte ratio (NLR), platelet (P or PLT), platelet-to-neutrophil ratio (PNR), NLR-to-platelet ratio (NLR/PLT), eosinophil (E), neutrophil-to-eosinophil ratio (NER), monocyte (M), and monocyte-to-neutrophil ratio (MNR)
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