Day 3 Neutrophil-to-lymphocyte Ratio and Its Derived Indices Predict 90-day Poor Outcomes Following Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Overview

Journal Front Neurol

Specialty Neurology

Date 2025 Jan 2

PMID 39744114

Authors

Weiwei Gao

Arslan Annadurdyyev

Lingfeng Yu

Rong Huang

Bin Liu

Yixiong Lin

Huaiyi Li

Renjing Zhu

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the dynamic changes in neutrophil-to-lymphocyte ratio (NLR) and its derived indices following mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) and evaluate their predictive value for prognosis.

Methods: This single-center retrospective cohort study included AIS patients who underwent MT at Zhongshan Hospital of Xiamen University from January 2018 to February 2024. Peripheral blood samples were collected on admission, day 1, and day 3 after MT to determine the NLR, derived NLR (dNLR), and neutrophil-monocyte-to-lymphocyte ratio (NMLR). The primary endpoint was poor functional outcome at 90 days (modified Rankin scale score 3-6). The secondary endpoints included post-operative hemorrhagic transformation, malignant cerebral edema, in-hospital mortality, and 90-day all-cause mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate predictive performance, and multivariate logistic regression models were employed to explore the independent associations between inflammatory markers and prognosis.

Results: A total of 423 eligible patients were included. Both groups showed similar dynamic trends in inflammatory markers, peaking on day 1 post-MT and subsequently declining. However, the poor outcome group ( = 255, 60.28%) maintained higher levels on day 3, whereas the good outcome group showed a significant decreasing trend. ROC curve analysis revealed that the NLR (AUC = 0.85, 95% CI: 0.81-0.89), dNLR (AUC = 0.86, 95% CI: 0.82-0.89), and NMLR (AUC = 0.85, 95% CI: 0.81-0.89) on day 3 post-MT had the strongest predictive power for 90-day poor outcomes. After comprehensive adjustment for confounders, these inflammatory markers were independently associated with 90-day poor outcomes: for each unit increase in the NLR, the risk of poor outcome increased by 38% (OR = 1.38, 95% CI: 1.28-1.49,  < 0.001); for dNLR, it increased by 104% (OR = 2.04, 95% CI: 1.73-2.40,  < 0.001); and for NMLR, it increased by 35% (OR = 1.35, 95% CI: 1.26-1.45,  < 0.001).

Conclusion: Inflammatory markers (NLR, dNLR, and NMLR) on day 3 post-MT can serve as independent predictors of prognosis in AIS patients treated with MT. Dynamic monitoring of inflammatory markers may facilitate early risk stratification and guide individualized treatment strategies.

References

Ray M, Walters D, Bett J, Cameron J, Wood P, Aroney C . Platelet-monocyte aggregates predict troponin rise after percutaneous coronary intervention and are inhibited by Abciximab. Int J Cardiol. 2005; 101(2):249-55. DOI: 10.1016/j.ijcard.2004.03.033. View

Savitz S, Baron J, Fisher M . Stroke Treatment Academic Industry Roundtable X: Brain Cytoprotection Therapies in the Reperfusion Era. Stroke. 2019; 50(4):1026–1031. DOI: 10.1161/STROKEAHA.118.023927. View

Tu X, Yang W, Shi S, Wang C, Zhang G, Ni T . Spatio-temporal distribution of inflammatory reaction and expression of TLR2/4 signaling pathway in rat brain following permanent focal cerebral ischemia. Neurochem Res. 2010; 35(8):1147-55. DOI: 10.1007/s11064-010-0167-6. View

von Kummer R, Broderick J, Campbell B, Demchuk A, Goyal M, Hill M . The Heidelberg Bleeding Classification: Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy. Stroke. 2015; 46(10):2981-6. DOI: 10.1161/STROKEAHA.115.010049. View

Sharma D, Spring K, Bhaskar S . Neutrophil-lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis. Acta Neurol Scand. 2021; 144(5):486-499. DOI: 10.1111/ane.13493. View

Otxoa-de-Amezaga A, Miro-Mur F, Pedragosa J, Gallizioli M, Justicia C, Gaja-Capdevila N . Microglial cell loss after ischemic stroke favors brain neutrophil accumulation. Acta Neuropathol. 2018; 137(2):321-341. PMC: 6513908. DOI: 10.1007/s00401-018-1954-4. View

Liu G, Zhang W, Shangguan J, Zhu X, Wang W, Guo Q . Association of Derived Neutrophil-To-Lymphocyte Ratio With Prognosis of Coronary Heart Disease After PCI. Front Cardiovasc Med. 2021; 8:705862. PMC: 8484317. DOI: 10.3389/fcvm.2021.705862. View

Shi K, Tian D, Li Z, Ducruet A, Lawton M, Shi F . Global brain inflammation in stroke. Lancet Neurol. 2019; 18(11):1058-1066. DOI: 10.1016/S1474-4422(19)30078-X. View

Chen S, Cheng J, Ye Q, Ye Z, Zhang Y, Liu Y . Day 1 neutrophil-to-lymphocyte ratio (NLR) predicts stroke outcome after intravenous thrombolysis and mechanical thrombectomy. Front Neurol. 2022; 13:941251. PMC: 9396211. DOI: 10.3389/fneur.2022.941251. View

10.

Zhu Z, Fu Y, Tian D, Sun N, Han W, Chang G . Combination of the Immune Modulator Fingolimod With Alteplase in Acute Ischemic Stroke: A Pilot Trial. Circulation. 2015; 132(12):1104-1112. PMC: 4580515. DOI: 10.1161/CIRCULATIONAHA.115.016371. View

11.

Pang Y, Shao H, Yang Z, Fan L, Liu W, Shi J . The (Neutrophils + Monocyte)/Lymphocyte Ratio Is an Independent Prognostic Factor for Progression-Free Survival in Newly Diagnosed Multiple Myeloma Patients Treated With BCD Regimen. Front Oncol. 2020; 10:1617. PMC: 7492571. DOI: 10.3389/fonc.2020.01617. View

12.

Tang N, Gong X, Huang H, Meng Q . Activated neutrophil-derived exosomes contribute to blood-brain barrier damage and hemorrhagic transformation after cerebral ischemia/reperfusion. Brain Res. 2023; 1810:148374. DOI: 10.1016/j.brainres.2023.148374. View

13.

Dragu R, Huri S, Zukermann R, Suleiman M, Mutlak D, Agmon Y . Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction. Atherosclerosis. 2006; 196(1):405-412. DOI: 10.1016/j.atherosclerosis.2006.11.022. View

14.

Ross A, Hurn P, Perrin N, Wood L, Carlini W, Potempa K . Evidence of the peripheral inflammatory response in patients with transient ischemic attack. J Stroke Cerebrovasc Dis. 2007; 16(5):203-7. PMC: 2570354. DOI: 10.1016/j.jstrokecerebrovasdis.2007.05.002. View

15.

Wang Y, Yuan M, Ma Y, Shao C, Wang Y, Qi M . The Admission (Neutrophil+Monocyte)/Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Patients With Acute Myocardial Infarction. Front Cardiovasc Med. 2022; 9:870176. PMC: 9021423. DOI: 10.3389/fcvm.2022.870176. View

16.

Yu S, Arima H, Bertmar C, Clarke S, Herkes G, Krause M . Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol Sci. 2018; 387:115-118. DOI: 10.1016/j.jns.2018.02.002. View

17.

Bui T, Jickling G, Winship I . Neutrophil dynamics and inflammaging in acute ischemic stroke: A transcriptomic review. Front Aging Neurosci. 2023; 14:1041333. PMC: 9813499. DOI: 10.3389/fnagi.2022.1041333. View

18.

Kim J, Kawabori M, Yenari M . Innate inflammatory responses in stroke: mechanisms and potential therapeutic targets. Curr Med Chem. 2013; 21(18):2076-97. PMC: 4104826. DOI: 10.2174/0929867321666131228205146. View

19.

Liao R, Peng C, Li M, Li D, Jiang N, Li P . Comparison and validation of the prognostic value of preoperative systemic immune cells in hepatocellular carcinoma after curative hepatectomy. Cancer Med. 2018; 7(4):1170-1182. PMC: 5911633. DOI: 10.1002/cam4.1424. View

20.

Qian K, Hu J, Wang C, Xu C, Chen Y, Feng Q . Dynamic change of neutrophil-to-lymphocyte ratio and its predictive value of prognosis in acute ischemic stroke. Brain Behav. 2024; 14(7):e3616. PMC: 11237173. DOI: 10.1002/brb3.3616. View