Gao Weiwei, Annadurdyyev Arslan, Yu Lingfeng, Huang Rong, Liu Bin, Lin Yixiong, Li Huaiyi, Zhu Renjing
Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
School of Medicine, Xiamen University, Xiamen, China.
Front Neurol. 2024 Dec 18;15:1496628. doi: 10.3389/fneur.2024.1496628. eCollection 2024.
To investigate the dynamic changes in neutrophil-to-lymphocyte ratio (NLR) and its derived indices following mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) and evaluate their predictive value for prognosis.
This single-center retrospective cohort study included AIS patients who underwent MT at Zhongshan Hospital of Xiamen University from January 2018 to February 2024. Peripheral blood samples were collected on admission, day 1, and day 3 after MT to determine the NLR, derived NLR (dNLR), and neutrophil-monocyte-to-lymphocyte ratio (NMLR). The primary endpoint was poor functional outcome at 90 days (modified Rankin scale score 3-6). The secondary endpoints included post-operative hemorrhagic transformation, malignant cerebral edema, in-hospital mortality, and 90-day all-cause mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate predictive performance, and multivariate logistic regression models were employed to explore the independent associations between inflammatory markers and prognosis.
A total of 423 eligible patients were included. Both groups showed similar dynamic trends in inflammatory markers, peaking on day 1 post-MT and subsequently declining. However, the poor outcome group ( = 255, 60.28%) maintained higher levels on day 3, whereas the good outcome group showed a significant decreasing trend. ROC curve analysis revealed that the NLR (AUC = 0.85, 95% CI: 0.81-0.89), dNLR (AUC = 0.86, 95% CI: 0.82-0.89), and NMLR (AUC = 0.85, 95% CI: 0.81-0.89) on day 3 post-MT had the strongest predictive power for 90-day poor outcomes. After comprehensive adjustment for confounders, these inflammatory markers were independently associated with 90-day poor outcomes: for each unit increase in the NLR, the risk of poor outcome increased by 38% (OR = 1.38, 95% CI: 1.28-1.49, < 0.001); for dNLR, it increased by 104% (OR = 2.04, 95% CI: 1.73-2.40, < 0.001); and for NMLR, it increased by 35% (OR = 1.35, 95% CI: 1.26-1.45, < 0.001).
Inflammatory markers (NLR, dNLR, and NMLR) on day 3 post-MT can serve as independent predictors of prognosis in AIS patients treated with MT. Dynamic monitoring of inflammatory markers may facilitate early risk stratification and guide individualized treatment strategies.
探讨急性缺血性卒中（AIS）患者机械取栓（MT）后中性粒细胞与淋巴细胞比值（NLR）及其衍生指标的动态变化，并评估其对预后的预测价值。
本单中心回顾性队列研究纳入了2018年1月至2024年2月在厦门大学附属中山医院接受MT的AIS患者。在入院时、MT后第1天和第3天采集外周血样本，以测定NLR、衍生NLR（dNLR）和中性粒细胞-单核细胞与淋巴细胞比值（NMLR）。主要终点为90天时功能预后不良（改良Rankin量表评分3 - 6分）。次要终点包括术后出血转化、恶性脑水肿、住院死亡率和90天全因死亡率。采用受试者操作特征（ROC）曲线分析评估预测性能，并采用多因素逻辑回归模型探讨炎症标志物与预后之间的独立关联。
共纳入423例符合条件的患者。两组炎症标志物均呈现相似的动态趋势，在MT后第1天达到峰值，随后下降。然而，预后不良组（n = 255，60.28%）在第3天维持较高水平，而预后良好组则呈现显著下降趋势。ROC曲线分析显示，MT后第3天的NLR（AUC = 0.85，95%CI：0.81 - 0.89）、dNLR（AUC = 0.86，95%CI：0.82 - 0.89）和NMLR（AUC = 0.85，95%CI：0.81 - 0.89）对90天预后不良具有最强的预测能力。在对混杂因素进行全面调整后，这些炎症标志物与90天预后不良独立相关：NLR每增加1个单位，预后不良风险增加38%（OR = 1.38，95%CI：1.28 - 1.49，P < 0.001）；dNLR增加104%（OR = 2.04，95%CI：1.73 - 2.40，P < 0.001）；NMLR增加35%（OR = 1.35，95%CI：1.26 - 1.45，P < 0.001）。
MT后第3天的炎症标志物（NLR、dNLR和NMLR）可作为接受MT治疗的AIS患者预后的独立预测指标。动态监测炎症标志物可能有助于早期风险分层并指导个体化治疗策略。
