Neurological
Neutrophil-lymphocyte ratio as a prognostic tool in IVT-treated ischemic stroke
In acute ischemic stroke patients undergoing intravenous thrombolysis (IVT), a high neutrophil to lymphocyte ratio (NLR) may predict hemorrhagic transformation as well as poor functional outcomes after 3 months, according to study results published in BMC Neurology. The results also indicated that NLR on admission, not after IVT, was an independent risk factor for an increased risk of hemorrhagic transformation after IVT.
The role of the NLR as a prognostic tool in acute ischemic stroke patients receiving IVT is still debated. A team of researchers conducted a systematic review and meta-analysis to determine whether NLR was associated with poor prognosis after IVT and whether NLR on admission or after IVT affected outcomes in this patient population.
The analysis comprised 12 studies with 3641 patients published between 2015 and 2020. Standard intravenous thrombolytic therapy was used in all 12 studies. The association between NLR and hemorrhagic transformation after IVT was reported in 6 studies, and a higher NLR was associated with an increased risk of hemorrhagic transformation (odds ratio [OR], 1.33; P <.001). The results showed significant heterogeneity between studies (P <.001).
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Ten studies examined the relationship between NLR and 3-month poor functional outcome after IVT, and a higher NLR was positively associated with a higher risk of poor 3-month functional outcome (OR 1.64; P <0.001). The study investigators also found significant heterogeneity between these studies (P <0.001).
A total of 4 studies measured the association between NLR and 3-month mortality and found no significant associations between the two (OR 1.14; P = .120). Heterogeneity was also significant in these studies (P <.001).
Results of a subgroup analysis indicated that NLR on admission, not after IVT, was associated with a higher risk of hemorrhagic transformation (OR, 1.33; P = 0.039).
“Our results suggest that both the NLR on admission and the NLR after IVT were associated with poor functional outcome after 3 months, but the NLR after IVT appeared to have a stronger correlation with a poor outcome than the NLR on admission “, Concluded the study researchers. “However, due to the small sample size, future studies are warranted to determine the best time to draw blood for the NLR in predicting the outcome [patients with acute ischemic stroke] IVT received. “
Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.
reference
Wang C, Zhang Q, Ji M, Mang J, Xu Z. Prognostic value of the neutrophil-lymphocyte ratio in patients with acute ischemic stroke treated with intravenous thrombolysis: a systematic review and meta-analysis. BMC Neurol. 2021; 21 (1): 191. doi: 10.1186 / s12883-021-02222-8