Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy

Yao Feng; Xuesong Bai; Wei Li; Wenbo Cao; Xin Xu; Fan Yu; Zhaolin Fu; Qiuyue Tian; Xiaofan Guo; Tao Wang; Arman Sha; Yanfei Chen; Peng Gao; Yabing Wang; Jian Chen; Yan Ma; Fei Chen; Adam A Dmytriw; Robert W Regenhardt; Jie Lu; Qingfeng Ma; Bin Yang; Liqun Jiao

doi:10.3389/fimmu.2022.963111

Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy

Front Immunol. 2022 Oct 7:13:963111. doi: 10.3389/fimmu.2022.963111. eCollection 2022.

Authors

Yao Feng^{1

2}, Xuesong Bai^{1

2}, Wei Li^{1

3}, Wenbo Cao^{1

2}, Xin Xu^{1

2}, Fan Yu^{4

5}, Zhaolin Fu^{1

2}, Qiuyue Tian⁶, Xiaofan Guo⁷, Tao Wang^{1

2}, Arman Sha^{4

5}, Yanfei Chen^{1

2}, Peng Gao^{1

2

8}, Yabing Wang^{1

2}, Jian Chen¹, Yan Ma^{1

2}, Fei Chen⁹, Adam A Dmytriw¹⁰, Robert W Regenhardt¹⁰, Jie Lu^{4

5}, Qingfeng Ma⁹, Bin Yang^{1

2}, Liqun Jiao^{1

2

8}

Affiliations

¹ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
² China International Neuroscience Institute (China-INI), Beijing, China.
³ Department of Neurosurgery, Liaocheng Brain Hospital, Liaocheng, China.
⁴ Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁵ Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
⁶ Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.
⁷ Department of Neurology, Loma Linda University Health, Loma Linda, CA, United States.
⁸ Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁹ Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
¹⁰ Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.

Abstract

Purpose: Only approximately half of anterior circulation large vessel occlusion (LVO) patients receiving endovascular treatment (EVT) have a favorable outcome. The aim of this study was to explore the association of dynamic inflammatory markers (i.e., neutrophil to lymphocyte ratios, NLR, measured at different times after EVT) as well as other potential influencing factors with unfavorable outcome among acute ischemic stroke (AIS) patients who achieved complete reperfusion after EVT.

Methods: Patients treated with EVT for LVO between January 2019 to December 2021 were prospectively enrolled. Complete reperfusion was defined as modified thrombolysis in cerebral infarction (mTICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3-6 was defined as unfavorable outcome (i.e., futile reperfusion). A logistic regression analysis was performed with unfavorable outcome as a dependent variable. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were then used to determine the diagnostic values of NLR and other relevant factors.

Results: 170 patients with complete reperfusion (mTICI 3) were included in this study. Unfavorable outcome was observed in 70 (41.2%). Higher NLR within 24h (p=0.017) and at 3-7d (p=0.008) after EVT were an independent risk factors for unfavorable outcome at 3 months. In addition, older age, higher NIHSS scores, poor collaterals, and general anesthesia were independent predictors of unfavorable outcomes. When accounting for NLR, the diagnostic efficiency improved compared to conventional characteristics.

Conclusion: Our findings suggest that advanced age, increased stroke severity, poor collaterals, general anesthesia, and NLR are independent predictors for an unfavorable clinical outcome following complete reperfusion after EVT. Neuroinflammation may merit particular attention in future studies.

Keywords: NLR; acute ischemic stroke; endovascular treatment; inflammation; prognosis; reperfusion.

MeSH terms

Cerebral Infarction / etiology
Cerebral Infarction / therapy
Endovascular Procedures* / adverse effects
Humans
Ischemic Stroke* / diagnosis
Ischemic Stroke* / surgery
Lymphocytes
Neutrophils
Reperfusion
Thrombectomy / adverse effects
Treatment Outcome