Sharma Divyansh, Bhaskar Sonu M M
Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
University of New South Wales (UNSW), South Western Sydney Clinical School, Sydney, NSW, Australia.
J Cent Nerv Syst Dis. 2022 Jul 15;14:11795735221110373. doi: 10.1177/11795735221110373. eCollection 2022.
Both inflammation and thrombotic/hemostatic mechanisms may play a role in acute ischemic stroke (AIS) pathogenesis, and a biomarker, such as the platelet-to-lymphocyte ratio (PLR), considering both mechanisms may be of clinical utility.
This meta-analysis sought to examine the effect of PLR on functional outcomes, early neurological changes, bleeding complications, mortality, and adverse outcomes in AIS patients treated with reperfusion therapy (RT).
Systematic Review and Meta-Analysis.
Individual studies were retrieved from the PubMed/Medline, EMBASE and Cochrane databases. References thereof were also consulted. Data were extracted using a standardised data sheet, and systematic reviews and meta-analyses on the association of admission (pre-RT) or delayed (post-RT) PLR with defined clinical and safety outcomes were conducted. In the case of multiple delayed PLR timepoints, the timepoint closest to 24 hours was selected.
Eighteen studies (n=4878) were identified for the systematic review, of which 14 (n=4413) were included in the meta-analyses. PLR collected at admission was significantly negatively associated with 90-day good functional outcomes (SMD=-.32; 95% CI = -.58 to -.05; P=.020; z=-2.328), as was PLR collected at delayed timepoints (SMD=-.43; 95% CI = -.54 to -.32; P<.0001; z=-7.454). PLR at delayed timepoints was also significantly negatively associated with ENI (SMD=-.18; 95% CI = -.29 to -.08; P=.001. Conversely, the study suggested that a higher PLR at delayed timepoints may be associated with radiological bleeding and mortality. The results varied based on the type of RT administered.
A higher PLR is associated with worse outcomes after stroke in terms of morbidity, mortality, and safety outcomes after stroke.
炎症和血栓形成/止血机制可能在急性缺血性卒中（AIS）的发病机制中发挥作用，而血小板与淋巴细胞比值（PLR）等综合考虑这两种机制的生物标志物可能具有临床应用价值。
本荟萃分析旨在研究PLR对接受再灌注治疗（RT）的AIS患者功能结局、早期神经功能变化、出血并发症、死亡率和不良结局的影响。
系统评价和荟萃分析。
从PubMed/Medline、EMBASE和Cochrane数据库检索个体研究。还查阅了其参考文献。使用标准化数据表提取数据，并对入院时（RT前）或延迟时（RT后）PLR与明确的临床和安全结局之间的关联进行系统评价和荟萃分析。在存在多个延迟PLR时间点的情况下，选择最接近24小时的时间点。
共识别出18项研究（n=4878）用于系统评价，其中14项（n=4413）纳入荟萃分析。入院时采集的PLR与90天良好功能结局显著负相关（标准化均数差[SMD]=-.32；95%可信区间[CI]=-.58至-.05；P=.020；z=-2.328），延迟时间点采集的PLR也是如此（SMD=-.43；95%CI=-.54至-.32；P<.0001；z=-7.454）。延迟时间点的PLR与早期神经功能恶化（ENI）也显著负相关（SMD=-.18；95%CI=-.29至-.08；P=.001）。相反，该研究表明延迟时间点较高的PLR可能与影像学出血和死亡率相关。结果因所采用的RT类型而异。
较高的PLR与卒中后在发病率、死亡率和安全性结局方面更差的结果相关。
