Neutrophil/lymphocyte and platelet/lymphocyte ratios in acute cerebrovascular disease. Evaluation of utility in predicting hemorrhagic transformation.
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Abstract
Objective: To associate the Neutrophil/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR) with hemorrhagic ransformation (HT) in Ischemic Stroke (IS) in neurocritical patients.
Design: Retrospective, analytical, observational, cross-sectional study.
Scope: Neurocritical Care Unit of the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
Patients: Adults > 18 years of age with acute ischemic CVD, hospitalized from January 1, 2021 to December 31, 2021, selected by non-probabilistic convenience sampling.
Intervention: Identification of HT in a neuroimaging study, determination of functional status and mortality at 30 and 90 days. The cut-off AUC for HT prediction was established. With logistic regression and multivariate analysis, other factors associated with HT were determined.
Primary endpoint: Hemorrhagic transformation related to INL and IPL and with mRS at 30 and 90 days.
Results: 188 patients were included. The prevalence of HT was 12.8%. Mortality in HT at 30 days was 16.7%. The mean NLR was 5.81 (SD + 6.29), OR 1.33 (95% CI 0.65-2.69; p = 0.42) and value > 4.67 (S: 66.7 %-E: 63.2%), AUC 0.67, predicted TH. NLR > 3.46 predicted mRS 5-6 at 90 days, adj OR 2.57 (95% CI 1.48- 4.67; p = 0.001), AUC 0.74. The mean IPL was 192 (SD + 150), without reaching predictive capacity. Glycemia >140 mg/dL was associated with HT.
Conclusions: The NLR was associated in a directly proportional way with the increased risk of HT and with worse functional results at 90 days. PLR showed no association.
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References
Campbell BC V, Khatri P. Stroke. Lancet [Internet]. 2020 Jul; 396 (10244):129–42. Available from: https://linkinghub.elsevier.com/retrieve/pii/S014067362031179X
Phipps MS, Cronin CA. Management of acute ischemic stroke. BMJ [Internet]. 2020 Feb 13;368:l6983. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.l6983
European Stroke Organization. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008; 25: 457–507.
Powers WJ. Acute Ischemic Stroke. Solomon CG, editor. N Engl J Med [Internet]. 2020 Jul 16;383(3):252–60. Available from:
http://www.nejm.org/doi/10.1056/NEJMcp1917030
Campbell BCV, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Prim [Internet]. 2019;5(1). Available from: http://dx.doi.org/10.1038/s41572-019-0118-8
Sistema Nacional de Vigilancia Epidemiológica. Histórico Boletines epidemiológicos. México. Secretaría de Salud. Dirección Nacional de Epidemiología. 2021. Disponible en: https://www.gob.mx/salud/acciones-y-programas/historicoboletin-epidemiologico
Hong JM, Kim DS, Kim M. Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management. Front Neurol. 2021 Nov 30;12:703258. doi: 10.3389/fneur.2021.703258. PMID: 34917010; PMCID: PMC8669478.
Honig A, Percy J, Sepehry AA, Gomez AG, Field TS, Benavente OR. Hemorrhagic Transformation in Acute Ischemic Stroke: A Quantitative Systematic Review. J Clin Med. 2022;11(5).
Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J, et al. Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation. Front Neurol. 2021;12(May):1–15
Song M, Graubard BI, Rabkin CS, Engels EA. Neutrophil-to-lymphocyte ratio and mortality in the United States general population. Sci Rep [Internet]. 2021;11(1):1–9. Available from: https://doi.org/10.1038/s41598-020-79431-7
Lee SH, Uk Jang M, Kim Y, Park SY, Kim C, Kim YJ, et al. The neutrophil-tolymphocyte and platelet-to-lymphocyte ratios predict reperfusion and prognosis after endovascular treatment of acute ischemic stroke. J Pers Med. 2021;11(8).
Pikija S, Sztriha LK, Killer-Oberpfalzer M, Weymayr F, Hecker C, Ramesmayer C, et al. Neutrophil to lymphocyte ratio predicts intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke. J Neuroinflammation. 2018;15(1):1–7.
Yang Y, Xie D, Zhang Y. Increased platelet-to-lymphocyte ratio is an independent predictor of hemorrhagic transformation and in-hospital mortality among acute ischemic stroke with large-artery atherosclerosis patients. Int J Gen Med. 2021;14(July):7545–55.