Eosinophil-to-Neutrophil Ratio Predicts Poor Prognosis of Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis

Why the fuck are you predicting problems rather than solving them? Didn't your mentors and senior researchers tell you the only goal in stroke is 100% recovery? This does absolutely nothing to get there. 

Eosinophil-to-Neutrophil Ratio Predicts Poor Prognosis of Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis

Haoye Cai^1†, Honghao Huang^2,3†, Chenguang Yang^2,3†, Junli Ren^2,3, Jianing Wang^2,3, Beibei Gao⁴, Wenjing Pan^2,3, Fangyue Sun^2,3, Xinbo Zhou^2,3, Tian Zeng^2,3, Jingyu Hu^2,3, Yilin Chen^2,3, Shunkai Zhang^2* and Guangyong Chen^2*

• ¹Department of Rehabilitation Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
• ²Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
• ³School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
• ⁴Department of Internal Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

Background and Purpose: The eosinophil-to-neutrophil ratio (ENR) was recently reported as a novel inflammatory marker in acute ischemic stroke (AIS). However, few studies reported the predictive value of ENR in AIS patients, especially for those with intravenous thrombolysis.

Methods: Two hundred sixty-six AIS patients receiving intravenous thrombolysis were retrospectively recruited in this study and followed up for 3 months and 1 year. The Modified Rankin Scale (mRS) and the time of death were recorded. Poor outcome was defined as mRS 3–6. After excluding patients who were lost to follow-up, the remaining 250 patients were included in the 3-month prognosis analysis and the remaining 223 patients were included in the 1-year prognosis analysis.

Results: ENR levels in the patients were lower than those in the healthy controls. The optimal cutoff values for the ability of ENR × 10² to predict 3-month poor outcome were 0.74 with 67.8% sensitivity and 77.3% specificity. Patients with ENR × 10² ≥ 0.74 have a lower baseline National Institutes of Health Stroke Scale (NIHSS) score (median: 7 vs. 11, p < 0.001). After multivariate adjustment, patients with ENR × 10² ≥ 0.74 were more likely to come to a better 3-month outcome (OR = 0.163; 95% CI, 0.076–0.348, p < 0.001). At the 1-year follow-up, the patients with ENR × 10² ≥ 0.74 showed a lower risk of mortality (HR = 0.314; 95% CI, 0.135–0.731; p = 0.007).

Conclusions: A lower ENR is independently associated with a 3-month poor outcome and a 3-month and 1-year mortality in AIS patients treated with intravenous thrombolysis.

Introduction

Stroke is one of the leading causes of mortality and morbidity worldwide (1). Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) was recommended for acute ischemic stroke (AIS) patients within 4.5 h of stroke onset, and an increasing trend of r-tPA treatment was discovered over the past 13 years (2). However, there were still nearly half of patients who went into major disability or died after 3 months of stroke onset. Hence, it was vital to find an accurate and concise prognostic marker to better distinguish patients who have a higher risk for poor outcome.

A strong neuro-inflammatory response is characteristic of ischemic stroke (3). Neutrophil plays an important role in the vascular innate immune system, and its distribution was highly influenced by the administration r-tPA (4). A higher neutrophil level after r-tPA infusion is a predictive factor for parenchymal hemorrhage and poor function outcome of AIS (5). Another notable aspect of the acute inflammatory response involves a sustained and rapid reduction of blood eosinophil count (6). A previous study reported that eosinopenia is associated with severe stroke and poor prognosis the day after admission (7). In addition, without concomitant eosinopenia, high neutrophil counts alone may not predict for a short-term risk of mortality of AIS patients (8), suggesting a potential interaction between eosinophils and neutrophils in ischemic stroke.

The eosinophil-to-neutrophil ratio (ENR) is a novel biomarker that was reported to be associated with in-hospital mortality of patients with chronic obstructive pulmonary disease (COPD) (9). A recent study reported that a neutrophil-to-eosinophil ratio represents systemic inflammation and a higher neutrophil-to-eosinophil ratio at admission is related to higher odds of in-hospital mortality in AIS patients (10). However, limited by the accuracy of the instrument, eosinophil count may show a number of 0 in some patients and excluding these patients could introduce some bias. Therefore, ENR may be a more stable biomarker than the neutrophil-to-eosinophil ratio. We performed this retrospective observational cohort study, aiming to analyze the predictive value of ENR for the 3-month and 1-year prognosis of AIS patients treated with r-tPA intravenous thrombolysis.

More at link,