Pengyu Gong1, Yukai Liu1, Yachi Gong2, Gang Chen3, Xiaohao Zhang4, Siyu Wang1, Feng Zhou1, Rui Duan5, Wenxiu Chen6, Ting Huang1, Meng Wang1, Qiwen Deng1, Hongchao Shi1, Junshan Zhou7, Teng Jiang8, Yingdong Zhang9. 1. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China. 2. Department of Gerontology, Nantong Third People's Hospital, Nantong University, Nantong, 226006, Jiangsu, China. 3. Department of Neurology, Haimen Hospital Affiliated to Nantong University, Nantong, 226000, Jiangsu, China. 4. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210000, Jiangsu, China. 5. School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210000, Jiangsu, China. 6. Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China. 7. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China. zhoujunshan6807@163.com. 8. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China. jiang_teng@njmu.edu.cn. 9. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China. zhangyingdong@aliyun.com.
Abstract
BACKGROUND AND PURPOSE: 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). METHODS: AIS 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. RESULTS: Among 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. CONCLUSIONS: NLR, PLR, and LMR were associated with post-thrombolysis END. NLR and PLR may predict post-thrombolysis END. NLR was related to post-thrombolysis ENI.
BACKGROUND AND PURPOSE: 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). METHODS:AISpatients 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. RESULTS: Among 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. CONCLUSIONS: NLR, PLR, and LMR were associated with post-thrombolysis END. NLR and PLR may predict post-thrombolysis END. NLR was related to post-thrombolysis ENI.
Entities:
Keywords:
Acute ischemic stroke; Early neurological deterioration; Early neurological improvement; Intravenous thrombolysis; Lymphocyte to monocyte ratio; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio
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