Prandin Gabriele, Valente Mariarosaria, Zhang Liqun, Malhotra Paresh, Sacco Simona, Foschi Matteo, Ornello Raffaele, Levee Viva, Chulack Katherine, Sheikh Fahad, Fayez Feras, Toraldo Francesco, Maisano Domenico, Del Regno Caterina, Komauli Filippo, Jarmillo Adelaida Gartner, Al-Karadsheh Hakam, Zahid Hamza, Klein Piers, Abdalkader Mohamad, Manganotti Paolo, Lobotesis Kyriakos, Nguyen Thanh N, Banerjee Soma, Gigli Gian Luigi, Merlino Giovanni, D'Anna Lucio
Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy.
Stroke Unit, Udine University Hospital, Udine, Italy; Clinical Neurology, Udine University Hospital and DMED, University of Udine, Udine, Italy.
J Neurol Sci. 2025 Aug 15;475:123587. doi: 10.1016/j.jns.2025.123587. Epub 2025 Jun 16.
Inflammation contributes to brain injury in acute ischemic stroke, but its role among patients treated with mechanical thrombectomy (MT) for large vessel occlusion (LVO) has not been fully established. The aim of this study was to explore the relationship between functional prognosis and the neutrophil-to-lymphocyte ratio (NLR) and derived ratios in patients undergoing MT.
This is a multicentre retrospective analysis of 970 consecutive patients treated with MT. Blood samples were collected on admission and after 24 h. Logistic regression was performed to assess the relationship between the ratios and 90-day modified Rankin scale (mRS) 0-2. Receiver-operating-characteristic (ROC) curves were used to estimate the ability of NLR and other ratios to predict the outcome. Restricted-cubic-spline (RCS) was used to investigate the association between NLR and 90-day mRS 3-6 and to determine a critical threshold.
The 24-h NLR showed the strongest predictive performance (AUC = 0.670 alone; AUC = 0.784 when combined with other clinical variables) in patients treated with MT. An optimal NLR cutoff of 4.30 was identified, with patients below this threshold less likely to have poor 90-day outcome (RR 0.76 [95 % CI 0.65-0.89] p = 0.001) and significant shift toward better 90-day mRS scores (cOR 0.55, 95 %CI 0.40-0.74; p < 0.001). Restricted cubic spline analysis confirmed the cutoff's significance in predicting unfavourable mRS shifts.
This study highlights the 24-h NLR as a powerful predictor of stroke outcomes post-MT, with a threshold of 4.30 strongly associated with poor prognosis. These findings suggest that NLR can guide personalized treatment approaches to improve recovery trajectories.
炎症在急性缺血性卒中中导致脑损伤，但其在接受机械取栓术（MT）治疗的大血管闭塞（LVO）患者中的作用尚未完全明确。本研究旨在探讨接受MT治疗的患者功能预后与中性粒细胞与淋巴细胞比值（NLR）及衍生比值之间的关系。
这是一项对970例连续接受MT治疗患者的多中心回顾性分析。入院时及24小时后采集血样。进行逻辑回归以评估这些比值与90天改良Rankin量表（mRS）0 - 2之间的关系。采用受试者操作特征（ROC）曲线来估计NLR及其他比值预测预后的能力。使用限制立方样条（RCS）来研究NLR与90天mRS 3 - 6之间的关联并确定临界阈值。
在接受MT治疗的患者中，24小时NLR显示出最强的预测性能（单独AUC = 0.670；与其他临床变量联合时AUC = 0.784）。确定了最佳NLR临界值为4.30，低于该阈值的患者90天预后不良的可能性较小（风险比0.76 [95% CI 0.65 - 0.89]，p = 0.001），且90天mRS评分显著向更好的方向转变（校正比值比0.55，95%CI 0.40 - 0.74；p < 0.001）。限制立方样条分析证实了该临界值在预测不良mRS转变方面的意义。
本研究强调24小时NLR是MT术后卒中预后的有力预测指标，临界值4.30与预后不良密切相关。这些发现表明NLR可指导个性化治疗方法以改善恢复轨迹。
