Association Between Neutrophil-to-Lymphocyte Ratio/Lymphocyte-to-Monocyte Ratio and In-Hospital Clinical Outcomes in Ischemic Stroke Treated with Intravenous Thrombolysis

Guangshuo Li; Yahui Hao; Chuanying Wang; Shang Wang; Yunyun Xiong; Xingquan Zhao

doi:10.2147/JIR.S382876

Association Between Neutrophil-to-Lymphocyte Ratio/Lymphocyte-to-Monocyte Ratio and In-Hospital Clinical Outcomes in Ischemic Stroke Treated with Intravenous Thrombolysis

J Inflamm Res. 2022 Sep 24:15:5567-5578. doi: 10.2147/JIR.S382876. eCollection 2022.

Authors

Guangshuo Li¹, Yahui Hao², Chuanying Wang¹, Shang Wang^{1

2}, Yunyun Xiong^#^{1

2

3}, Xingquan Zhao^#¹

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
² China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
³ Chinese Institute of Brain Research, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Objective: Investigations on neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in patients with ischemic stroke are insufficient. We aimed to investigate the relationship of NLR and LMR with in-hospital clinical outcomes at different time points in ischemic stroke patients treated with intravenous tissues plasminogen activator (IV tPA).

Methods: We retrospectively enrolled patients who received IV tPA therapy within 4.5 hours from symptoms onset. Demographics, clinical characteristics, imaging measures, and the in-hospital clinical outcomes including early neurological improvement (ENI, defined as NIHSS score reduction within 24 hours ≥4 points or decreased to the baseline) and favorable functional outcome (defined as modified Rankin scale 0-1) were collected. Multivariable logistic regression analyses were performed to test whether NLR or LMR was an independent predictor for the in-hospital clinical outcomes.

Results: One hundred and two patients treated with IV tPA were included. NLR at 24 hours proved to be an independent predictor of ENI (adjusted OR=0.85, 95% CI=0.75-0.95, P=0.04). NLR at 48 hours and LMR at 48 hours proved to be independent predictors of mRS 0-1 at discharge (NLR at 48 hours: adjusted OR=0.64, 95% CI=0.49-0.83, P=0.01; LMR at 48 hours: adjusted OR=1.50, 95% CI=1.08-2.09, P=0.02). The AUC of NLR at 48 hours to predict favorable functional outcome at discharge was 0.79 (95% CI=0.70-0.88, P<0.001) and the optimal cut-off was 5.69 (sensitivity=0.52, specificity=0.63).

Conclusion: In our study, NLR at 24 hours was correlated with ENI. Both NLR and LMR at 48 hours were closely associated with favorable functional outcomes at discharge.

Keywords: inflammation; neutrophil; stroke; thrombolysis; tissue plasminogen activator.

Grants and funding

This work was supported by grants from Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2019-I2M-5-029), the National Natural Science Foundation (82171272), Beijing Municipal Science & Technology Commission (Z211100003521019), Beijing Hospitals Authority (PX2022019), Ministry of Finance of the People’s Republic of China [issued by Finance and Social Security [2015] Document No. 82; [2016] Document No. 50; [2017] Document No. 72; [2018] Document No. 48; [2019] Document No. 77; [2020] Document No. 75; [2021] Document No. 84, Ministry of Finance], and Beijing Hospitals Authority Innovation Studio of Young Staff Funding Support, code: 202112.