Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
Key Laboratory of Alzheimer's Disease of Zhejiang Province, Institute of Aging, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Neurol Sci. 2023 Jul;44(7):2431-2442. doi: 10.1007/s10072-023-06654-7. Epub 2023 Feb 20.
This study aimed at the population receiving thrombolytic therapy and to explore the optimal time point for neutrophil-to-lymphocyte ratio (NLR) in predicting stroke-associated pneumonia (SAP).
We assessed patients undergoing intravenous thrombolysis (IVT) for acute ischemic stroke. Blood parameters were sampled before thrombolysis (within 30 min after admission) and within 24-36 h after thrombolysis, respectively. The primary outcome measure was the occurrence of SAP. Multivariate logistic regression analysis was performed to analyze the association between admission blood parameters and the event of SAP. We also used receiver operating characteristic (ROC) curve analysis to assess the discriminative ability of blood parameters measured at different times in predicting SAP.
Among the 388 patients, SAP occurred in 60 (15%) patients. Multivariate logistic regression analysis showed that NLR was significantly associated with SAP (NLR before IVT: aOR = 1.288; 95%CI = 1.123-1.476; p < 0.001; NLR after IVT: (aOR = 1.127, 95%CI = 1.017-1.249; p = 0.023). The ROC curve showed that the predictive ability of NLR after IVT was better than NLR before IVT, not only in predicting the occurrence of SAP but also in predicting short-term and long-term functional outcomes, hemorrhagic transformation, and 1-year mortality.
Increased NLR measured within 24-36 h after IVT has a significant predictive effect on the occurrence of SAP and can be used to predict short-term and long-term poor functional outcomes, hemorrhagic transformation, and 1-year mortality.
本研究旨在探讨接受溶栓治疗的人群中，中性粒细胞与淋巴细胞比值（NLR）预测卒中相关性肺炎（SAP）的最佳时间点。
我们评估了接受急性缺血性脑卒中静脉溶栓（IVT）治疗的患者。分别在溶栓前（入院后 30 分钟内）和溶栓后 24-36 小时内采集血液参数。主要结局测量指标为 SAP 的发生情况。采用多变量逻辑回归分析来分析入院时血液参数与 SAP 发生事件之间的关联。我们还使用接受者操作特征（ROC）曲线分析来评估不同时间点测量的血液参数预测 SAP 的区分能力。
在 388 例患者中，60 例（15%）患者发生 SAP。多变量逻辑回归分析表明，NLR 与 SAP 显著相关（溶栓前 NLR：优势比[OR] = 1.288；95%置信区间[CI] = 1.123-1.476；p < 0.001；溶栓后 NLR：OR = 1.127，95%CI = 1.017-1.249；p = 0.023）。ROC 曲线显示，溶栓后 NLR 的预测能力优于溶栓前 NLR，不仅在预测 SAP 的发生方面，而且在预测短期和长期功能结局、出血转化和 1 年死亡率方面。
IVT 后 24-36 小时内测量的 NLR 升高对 SAP 的发生具有显著的预测作用，并可用于预测短期和长期不良功能结局、出血转化和 1 年死亡率。
