The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke

Pengyu Gong,Ting Huang,Feng Zhou,Siyu Wang,Wenxiu Chen,Meng Wang,Yingdong Zhang,Junshan Zhou,Rui Duan,Gang Chen,Teng Jiang,Yukai Liu,Xiaohao Zhang,Hongchao Shi,Qiwen Deng,Yachi Gong

doi:10.1186/s12974-021-02090-6

Abstract

Background and purposeTo investigate the association of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS).MethodsAIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as the National Institutes of Health Stroke Scale (NIHSS) score increase of ≥ 4 within 24 h after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥ 4 or complete recovery within 24 h. Multinomial logistic regression analysis was performed to explore the relationship of NLR, PLR, and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI.ResultsAmong 1060 recruited patients, a total of 193 (18.2%) were diagnosed with END and 398 (37.5%) were diagnosed with ENI. Multinomial logistic model indicated that NLR (odds ratio [OR], 1.385; 95% confidence interval [CI] 1.238–1.551, P = 0.001), PLR (OR, 1.013; 95% CI 1.009–1.016, P = 0.001), and LMR (OR, 0.680; 95% CI 0.560–0.825, P = 0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.713; 95% CI 0.643–0.791, P = 0.001) served as an independent factor for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR, and LMR to discriminate END were 0.763, 0.703, and 0.551, respectively. AUC of NLR, PLR, and LMR to discriminate ENI were 0.695, 0.530, and 0.547, respectively.ConclusionsNLR, PLR, and LMR were associated with post-thrombolysis END. NLR and PLR may predict post-thrombolysis END. NLR was related to post-thrombolysis ENI.

Highlights

Stroke is one of the main reasons for mortality and morbidity at the national level in China [1, 2]
Multinomial logistic model indicated that neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) (OR, 1.013; 95% 95% Confidence interval (CI) 1.009–1.016, P = 0.001), and lymphocyte to monocyte ratio (LMR) (OR, 0.680; 95% CI 0.560–0.825, P = 0.001) were independent factors for post-thrombolysis early neurological deterioration (END)
NLR (OR, 0.713; 95% CI 0.643–0.791, P = 0.001) served as an independent factor for post-thrombolysis early neurological improvement (ENI)

Summary

Introduction

Stroke is one of the main reasons for mortality and morbidity at the national level in China [1, 2]. The efficacy of thrombolysis with intravenous recombinant tissue plasminogen activator was demonstrated for the patients with acute ischemic stroke (AIS) [3,4,5]. It has been reported that rapid recovery, which is described as early neurological improvement (ENI), can be observed in a significant proportion of AIS patients within the first 24 h after intravenous thrombolysis [3, 4]. Post-thrombolysis ENI can promote acceptable longterm outcomes for the patients with AIS [9], and END results in the increasing likelihood of mortality and morbidity [10]. To investigate the association of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS)

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