Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke

Mei-Qi Wang; Ying-Ying Sun; Yan Wang; Xiu-Li Yan; Hang Jin; Xin Sun; Peng Zhang; Hong-Jing Zhu; Zhen-Ni Guo; Yi Yang

doi:10.2174/1567202617666200517111802

Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke

Curr Neurovasc Res. 2020;17(4):411-419. doi: 10.2174/1567202617666200517111802.

Authors

Mei-Qi Wang¹, Ying-Ying Sun¹, Yan Wang¹, Xiu-Li Yan¹, Hang Jin¹, Xin Sun¹, Peng Zhang², Hong-Jing Zhu¹, Zhen-Ni Guo², Yi Yang¹

Affiliations

¹ Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin, China.
² Department of Neurology, Clinical Trail and Research Center for Stroke, The First Hospital of Jilin University, Chang Chun, Jilin, China.

Abstract

Background and purpose: Platelet-to-neutrophil ratio (PNR) was suggested to be an independent protective predictor for 90-days outcomes in acute ischemic stroke (AIS) patients in previous studies. This study aims to investigate the association between PNR and outcomes of AIS in intravenous thrombolysis (IVT) group.

Methods: Data on acute ischemic stroke patients who received intravenous thrombolysis from April 2015 to March 2019 were collected. We defined the PNR value at admission as pre-IVT PNR and after IVT within 24 h was defined as post-IVT PNR. Clinical outcome indicators included early neurological deterioration (END), hemorrhagic transformation (HT), delayed neurological deterioration (DND), and poor 3-month outcome (3m-mRS >2).

Results: A total of 581 patients were enrolled in the final analysis. The age was 61(53-69) years, and 423(72.8%) were males. Post-IVT PNR was independently associated with hemorrhagic transformation (OR = 0.974; 95%CI = 0.956-0.992; P=0.006), early neurological deterioration (OR = 0.939; 95%CI = 0.913-0.966; P = 0.01), delayed neurological deterioration (OR = 0.949; 95%CI = 0.912- 0.988; P = 0.011), and poor outcome (OR = 0.962; 95%CI = 0.948-0.976; P<0.001). PNR level was identified as high (at the cut-off value or above) or low (below the cut-off value) according to receiver operating curve (ROC) analyses on each endpoint. Comparison of early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome (3m-mRS >2) between patients at high and low levels for platelet-to-neutrophil ratio (PNR) showed statistical differences (p<0.001).

Conclusion: Post-IVT PNR was independently associated with early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome. Lower PNR can predict a worse outcome.

Keywords: Acute ischemic stroke; delayed neurological deterioration; early neurological deterioration; hemorrhagic transformation; intravenous thrombolysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Intravenous / adverse effects
Administration, Intravenous / trends*
Aged
Blood Platelets / metabolism*
Brain Ischemia / blood*
Brain Ischemia / diagnosis
Brain Ischemia / therapy
Female
Humans
Ischemic Stroke / blood*
Ischemic Stroke / diagnosis
Ischemic Stroke / therapy
Male
Middle Aged
Neutrophils / metabolism*
Predictive Value of Tests
Retrospective Studies
Thrombolytic Therapy / adverse effects
Thrombolytic Therapy / trends*
Treatment Outcome

Grants and funding

This work was supported by the National Natural Science Foundation of China (Grant no. 81771243), the Program for JLUSTIRT (Grant no. 2017TD-12), and the Jilin Provincial Key Laboratory (Grant no. 20190901005JC) to Yi Yang.