Higher fibrinogen and neutrophil-to-lymphocyte ratio are associated with the early poor response to intravenous thrombolysis in acute ischemic stroke

Mingzhu Deng; Kangping Song; Yangping Tong; Sufen Chen; Wei Xu; Guohua He; Jue Hu; Hui Xiao; Changmin Wan; Zhen Wang; Fangyi Li

doi:10.3389/fneur.2024.1291950

Higher fibrinogen and neutrophil-to-lymphocyte ratio are associated with the early poor response to intravenous thrombolysis in acute ischemic stroke

Front Neurol. 2024 Feb 22:15:1291950. doi: 10.3389/fneur.2024.1291950. eCollection 2024.

Authors

Mingzhu Deng^#¹, Kangping Song^#², Yangping Tong², Sufen Chen², Wei Xu², Guohua He², Jue Hu², Hui Xiao², Changmin Wan², Zhen Wang², Fangyi Li²

Affiliations

¹ Department of Neurology, Brain Hospital of Hunan Province, The Second People's Hospital of Hunan Province, Changsha, Hunan, China.
² Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China.

^# Contributed equally.

Abstract

Background: Inflammation and platelet activation play pivotal roles in acute ischemic stroke (AIS) pathogenesis. Early response to thrombolysis is a vital indicator for the long-term prognosis of AIS. However, the correlation between fibrinogen or the neutrophil-to-lymphocyte ratio (NLR) and the early response to intravenous thrombolysis in patients with AIS remains unclear.

Methods: AIS patients undergoing intravenous thrombolysis were enrolled between January 2018 and May 2023. Blood cell counts were sampled before thrombolysis. A good response was defined as a National Institutes of Health Stroke Scale (NIHSS) score decreased ≥4 or complete recovery 24 h after thrombolysis treatment. A poor response was defined as any increase in the NIHSS score or a decrease in the NIHSS score <4 at the 24 h after thrombolysis treatment compared with that at admission. Logistic regression analysis was performed to explore the relationship of the fibrinogen level and NLR with a poor thrombolysis response. Receiver operating characteristic (ROC) analysis was used to assess the ability of the fibrinogen level and NLR to discriminate poor responders.

Results: Among 700 recruited patients, 268 (38.29%) were diagnosed with a good response, and 432 (61.71%) were diagnosed with a poor response to intravenous thrombolysis. A binary logistic regression model indicated that an elevated fibrinogen level (odds ratio [OR], 1.693; 95% confidence interval [CI] 1.325-2.122, P < 0.001) and NLR (OR, 1.253; 95% CI, 1.210-2.005, P = 0.001) were independent factors for a poor response. The area under the curve (AUC) values for the fibrinogen level, NLR and fibrinogen level combined with the NLR for a poor response were 0.708, 0.605, and 0.728, respectively.

Conclusions: Our research indicates that the levels of fibrinogen and NLR at admission can be used as a prognostic factor to predict early poor response to intravenous thrombolysis.

Keywords: acute ischemic stroke; fibrinogen; intravenous thrombolysis; neutrophil-to-lymphocyte ratio; response.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Medical Clinical Research 4310 Project of University of South China (No. KJZX2021078).