Analysis of the prognostic value of emergency blood tests in ischaemic stroke

J Marta-Enguita; I Rubio-Baines; N Aymerich; M Herrera; B Zandio; S Mayor; C Roncal; M Mendioroz; J Orbe; R Muñoz

doi:10.1016/j.nrleng.2022.03.007

Analysis of the prognostic value of emergency blood tests in ischaemic stroke

Neurologia (Engl Ed). 2022 Nov 17:S2173-5808(22)00176-6. doi: 10.1016/j.nrleng.2022.03.007. Online ahead of print.

Authors

J Marta-Enguita¹, I Rubio-Baines², N Aymerich³, M Herrera⁴, B Zandio⁴, S Mayor², C Roncal⁵, M Mendioroz⁶, J Orbe⁷, R Muñoz⁸

Affiliations

¹ Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain.
² Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain.
³ Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain.
⁴ Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain.
⁵ Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; CIBERCV, ISCIII, Madrid, Spain.
⁶ Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain; Laboratorio de Neuroepigénetica, NavarraBiomed, Pamplona, Spain.
⁷ Laboratorio Aterotrombosis, CIMA-Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain.
⁸ Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria Navarra, IdiSNA, Pamplona, Spain; RICORS-Enfermedades Cerebrovasculares, ISCIII, Madrid, Spain. Electronic address: roberto.munoz.arrondo@navarra.es.

PMID: 36402398
DOI: 10.1016/j.nrleng.2022.03.007

Abstract

Objectives: This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke.

Methods: We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index.

Results: An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy.

Conclusions: Basic blood test parameters provide important prognostic information for stroke patients and should therefore be analysed in combination with standard clinical and radiological parameters to optimise ischaemic stroke management.

Keywords: Analítica urgente; Emergency blood test; Functional prognosis; Haemorrhagic transformation; Ictus isquémico; Ischaemic stroke; Mortalidad; Mortality; Neutrophil-to-lymphocyte ratio; Pronóstico funcional; Ratio neutrófilos/linfocitos; Transformación hemorrágica.