The effects of changes in platelet-to-neutrophil ratios 24 hours after intravenous thrombolysis on prognosis in acute ischemic stroke patients.

To investigate the prognostic value of Platelet-to-Neutrophil ratio on admission (PNR on admission) and 24 h after intravenous thrombolysis (24 h PNR) in acute ischemic stroke patients (AIS) patients. One hundred fifty-one ischemic stroke patients receiving intravenous thrombolysis were retrospectively recruited in this study. Complete blood count evaluations for PNR were conducted on admission and 24 h after the treatment of thrombolysis. The poor outcome at 3months was defined as the modified Rankin Scale of 3-6. In multivariate logistic regression, PNR on admission (odds ratio [OR] = 0.967, 95 % confidence interval [CI] = 0.939-0.996; P = 0.028), and 24 h PNR(OR = 0.933, 95 %CI = 0.895-0.972; P = 0.004) were all independent indicators for the 3-month poor prognosis in ischemic stroke patients receiving intravenous thrombolysis. The area under the curve of PNR on admission to predict poor functional outcomes at 3 months was 0.645 (95 %CI = 0.558-0.732; P < 0.001), and the best predictive PNR on admission value was 41.35. After the treatment of thrombolysis, the area under the curve of 24 h PNR to predict poor functional outcomes at 3 months was 0.796 (95 %CI = 0.722-0.858; P < 0.001), and the best predictive 24 h PNR value was 31.03. Both the PNR on admission and 24 h PNR were independently associated with poor functional outcomes. Compared with the PNR on admission, 24 h PNR may serve as a more reliable marker for a poor prognosis in ischemic stroke patients receiving intravenous thrombolysis.

Pan H ，Fu M ，Ge W ，Zhou C ... -  《-》

Association of Admission Leukocyte Count with Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator.

An increased leukocyte count is positively associated with poor outcomes and all-cause mortality in coronary heart disease, cancer, and ischemic stroke. The role of leukocyte count in acute ischemic stroke (AIS) remains important. We aimed to investigate the association between admission leukocyte count before thrombolysis with recombinant tissue plasminogen activator (rt-PA) and 3-month outcomes in AIS patients. This retrospective study included consecutive AIS patients who received intravenous (IV) rt-PA within 4.5 h of symptom onset between January 2016 to December 2018. We assessed outcomes, including short-term hemorrhagic transformation (HT), 3-month mortality, and functional independence (modified Rankin Scale [mRS] score of 0-2 or 0-1). Among 579 patients who received IV rt-PA, 77 (13.3%) exhibited HT at 24 h, 43 (7.4%) died within 3 months, and 211 (36.4%) exhibited functional independence (mRS score: 0-2). Multivariable logistic regression revealed admission leukocyte count as an independent predictor of good and excellent outcomes at 3 months. Each 1-point increase in admission leukocyte count increased the odds of poor outcomes at 3 months by 7.6% (mRS score: 3-6, odds ratio [OR]: 1.076, 95% confidence interval [CI]: 1.003-1.154, p=0.041) and 7.8% (mRS score: 2-6, OR: 1.078, 95% CI: 1.006-1.154, p=0.033). Multivariable regression analysis revealed no association between HT and 3-month mortality. Admission neutrophil and lymphocyte count were not associated with 3-- month functional outcomes or 3-month mortality. A lower admission leukocyte count independently predicts good and excellent outcomes at 3 months in AIS patients undergoing rt-PA treatment.

Chen J ，Zhang FL ，Lv S ，Jin H ，Luo Y ，Qu Y ，Guo ZN ，Yang Y ... -  《-》

Eosinophil-to-Monocyte Ratio is a Potential Predictor of Prognosis in Acute Ischemic Stroke Patients After Intravenous Thrombolysis.

Eosinophil and monocyte have been demonstrated separately to be independent predictors of acute ischemic stroke (AIS). This study aimed to evaluate the association between eosinophil-to-monocyte ratio (EMR) and 3-month clinical outcome after treatment with recombinant tissue plasminogen activator (rt-PA) for AIS patients. Simultaneously, we made a simple comparison with other prognostic indicators, such as 24h neutrophil-to-lymphocyte ratio (NLR) and 24h platelet-to-lymphocyte ratio (PLR) to investigate the prognostic value of EMR. A total of 280 AIS patients receiving intravenous thrombolysis were retrospectively recruited for this study. Complete blood count evaluations for EMR were conducted on 24 hours admission. The poor outcome at 3-month was defined as the modified Rankin Scale (mRS) of 3-6 and the mRS score for death was 6. The EMR levels in patients with AIS were lower than those in the healthy controls and showed a negative correlation with the NIHSS score. At the 3-month follow-up, multivariate logistic regression analysis indicated an association among EMR, poor outcome and mortality. In addition, EMR had a higher predictive ability than popular biomarkers like NLR and PLR for 3-month mortality. The lower levels of EMR were independently associated with poor outcome and dead status in AIS patients.

Chen Y ，Ren J ，Yang N ，Huang H ，Hu X ，Sun F ，Zeng T ，Zhou X ，Pan W ，Hu J ，Gao B ，Zhang S ，Chen G ... -  《Clinical Interventions in Aging》

Correlation between the B-type Natriuretic Peptide before thrombolysis and prognosis in patients with ischemic stroke.

Elevated levels of B-type natriuretic peptide (BNP) can predict the prognosis of patients with acute ischemic stroke (AIS). However, the association between BNP levels and the clinical outcome in patients with AIS receiving intravenous thrombolysis treatment remains controversial. Therefore, this study aimed to analyse the role of BNP in patients with ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) therapy. This retrospective study involved 251 patients who were diagnosed with ischemic stroke and had undergone intravenous thrombolysis. The BNP level in blood was assessed before the treatment of thrombolysis. Outcome events include poor functional outcome, and mortality defined as modified Rankin Scale (mRS) scores of 3-6,and 6 respectively. In multivariate logistic regression, BNP > 78 pg/mL (odds ratio, 2.726 [95% CI, 1.440-5.159]; P = 0.002) was an independent risk factor for 3-month poor outcomes in patients with ischemic stroke treated with thrombolysis, whereas BNP > 103 pg/mL (odds ratio, 4.204 [95% CI, 1.382-12.788]; P = 0.011) was significantly associated with the 3-month mortality. The area under the curve (AUC) of BNP before thrombolysis to predict poor functional outcomes at 3 months were 0.679 (95% CI, 0.618-0.737; P < 0.001), and mortality at 3 months was 0.802 (95% CI, 0.747-0.849; P < 0.001), respectively. An early increase in BNP levels before intravenous thrombolysis was independently associated with 3-month poor outcomes and mortality. Moreover, the pre-thrombolytic BNP level may serve as a more reliable marker for predicting mortality in patients with ischemic stroke.

Pan H ，Feng K ，Fu M ，Ge W ，Zhou C ... -  《-》

Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke.

Platelet-to-neutrophil ratio (PNR) was suggested to be an independent protective predictor for 90-days outcomes in acute ischemic stroke (AIS) patients in previous studies. This study aims to investigate the association between PNR and outcomes of AIS in intravenous thrombolysis (IVT) group. Data on acute ischemic stroke patients who received intravenous thrombolysis from April 2015 to March 2019 were collected. We defined the PNR value at admission as pre-IVT PNR and after IVT within 24 h was defined as post-IVT PNR. Clinical outcome indicators included early neurological deterioration (END), hemorrhagic transformation (HT), delayed neurological deterioration (DND), and poor 3-month outcome (3m-mRS >2). A total of 581 patients were enrolled in the final analysis. The age was 61(53-69) years, and 423(72.8%) were males. Post-IVT PNR was independently associated with hemorrhagic transformation (OR = 0.974; 95%CI = 0.956-0.992; P=0.006), early neurological deterioration (OR = 0.939; 95%CI = 0.913-0.966; P = 0.01), delayed neurological deterioration (OR = 0.949; 95%CI = 0.912- 0.988; P = 0.011), and poor outcome (OR = 0.962; 95%CI = 0.948-0.976; P<0.001). PNR level was identified as high (at the cut-off value or above) or low (below the cut-off value) according to receiver operating curve (ROC) analyses on each endpoint. Comparison of early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome (3m-mRS >2) between patients at high and low levels for platelet-to-neutrophil ratio (PNR) showed statistical differences (p<0.001). Post-IVT PNR was independently associated with early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome. Lower PNR can predict a worse outcome.

Wang MQ ，Sun YY ，Wang Y ，Yan XL ，Jin H ，Sun X ，Zhang P ，Zhu HJ ，Guo ZN ，Yang Y ... -  《-》