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. 2021 Feb 20;18(1):51.
doi: 10.1186/s12974-021-02090-6.

The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke

Pengyu Gong #  1 , Yukai Liu #  1 , Yachi Gong  2 , Gang Chen  3 , Xiaohao Zhang  4 , Siyu Wang  1 , Feng Zhou  1 , Rui Duan  5 , Wenxiu Chen  6 , Ting Huang  1 , Meng Wang  1 , Qiwen Deng  1 , Hongchao Shi  1 , Junshan Zhou  7 , Teng Jiang  8 , Yingdong Zhang  9
Affiliations

The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke

Pengyu Gong et al. J Neuroinflammation. .

Abstract

Background and purpose: To investigate the association of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS).

Methods: AIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as the National Institutes of Health Stroke Scale (NIHSS) score increase of ≥ 4 within 24 h after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥ 4 or complete recovery within 24 h. Multinomial logistic regression analysis was performed to explore the relationship of NLR, PLR, and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI.

Results: Among 1060 recruited patients, a total of 193 (18.2%) were diagnosed with END and 398 (37.5%) were diagnosed with ENI. Multinomial logistic model indicated that NLR (odds ratio [OR], 1.385; 95% confidence interval [CI] 1.238-1.551, P = 0.001), PLR (OR, 1.013; 95% CI 1.009-1.016, P = 0.001), and LMR (OR, 0.680; 95% CI 0.560-0.825, P = 0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.713; 95% CI 0.643-0.791, P = 0.001) served as an independent factor for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR, and LMR to discriminate END were 0.763, 0.703, and 0.551, respectively. AUC of NLR, PLR, and LMR to discriminate ENI were 0.695, 0.530, and 0.547, respectively.

Conclusions: NLR, PLR, and LMR were associated with post-thrombolysis END. NLR and PLR may predict post-thrombolysis END. NLR was related to post-thrombolysis ENI.

Keywords: Acute ischemic stroke; Early neurological deterioration; Early neurological improvement; Intravenous thrombolysis; Lymphocyte to monocyte ratio; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The violin plot in distribution of composite inflammatory ratios (neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio) among the different early neurological outcome group. a The violin plot in distribution of neutrophil-lymphocyte ratio among the different early neurological outcome group. b The violin plot in distribution of platelet-lymphocyte ratio among the different early neurological outcome group. c The violin plot in distribution of lymphocyte-monocyte ratio among the different early neurological outcome group
Fig. 2
Fig. 2
Receiver operating characteristic curve for composite inflammatory ratios (neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio) to predict post-thrombolysis early neurological outcome. a Receiver operating characteristic curve to predict post-thrombolysis early neurological deterioration. b Receiver operating characteristic curve to predict post-thrombolysis early neurological improvement
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