Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.
Department of Neurological Surgery, University Hospital Newark, New Jersey Medical School, Rutgers, New Jersey, USA.
Interv Neuroradiol. 2023 Aug;29(4):386-392. doi: 10.1177/15910199221093896. Epub 2022 Apr 11.
The neutrophil-lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19.
We sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke.
We analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated.
Incidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27-87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p = .003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2-38.6, p = .03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2-52.4, p = .03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p = .043, TICI p = .070).
We show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy.
中性粒细胞与淋巴细胞比值（NLR）在多种医学病症中作为急性生理应激的重要生物标志物而逐渐显现，并且是 COVID-19 中确认的预后不良指标。
我们旨在描述 NLR 在预测接受机械取栓治疗的急性缺血性脑卒中合并大血管闭塞（LVO）的 COVID-19 患者不良结局中的作用。
我们分析了纳入一项国际 12 中心回顾性研究的实验室确诊 COVID-19 患者的 NLR，该研究连续纳入了 2020 年 3 月 1 日至 2020 年 5 月 1 日期间入组的 LVO 卒中患者。高 NLR 定义为≥7.2。生成逻辑回归模型。
LVO 卒中的发生率为 38/6698（0.57%）。患者的平均年龄为 62 岁（范围 27-87 岁），死亡率为 30%。年龄、性别和种族与死亡率无相关性。升高的 NLR 和较差的血管再通（脑梗死溶栓（TICI）评分 1 或 2a）协同预测不良结局（似然比 11.65，p=0.003）。NLR>7.2 的患者死亡的可能性高 6.8 倍（OR 6.8，95%CI 1.2-38.6，p=0.03），且需要长时间有创机械通气的可能性几乎高 8 倍（OR 7.8，95%CI 1.2-52.4，p=0.03）。在多变量分析中，即使控制低 TICI 评分对不良结局的影响，NLR>7.2 也预测不良结局（NLR p=0.043，TICI p=0.070）。
我们发现 COVID-19 合并 LVO 患者的 NLR 升高预示着结局显著恶化和死亡率增加，而与再通状态无关。与 COVID-19 相关的严重神经炎症应激反应可能抵消成功取栓的潜在获益。
