Deans' stroke musings: Association between neutrophil percentage-to-albumin ratio and 3-month functional outcome in acute ischemic stroke patients with reperfusion therapy

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, September 22, 2022

Association between neutrophil percentage-to-albumin ratio and 3-month functional outcome in acute ischemic stroke patients with reperfusion therapy

So you described a problem; WHAT THE FUCK IS THE SOLUTION? No solution, useless research, I'd fire you all.

Association between neutrophil percentage-to-albumin ratio and 3-month functional outcome in acute ischemic stroke patients with reperfusion therapy

Ting Cui¹^†,

Changyi Wang²^†,

Qiange Zhu³,

Shucheng Li¹,

Yuan Yang¹,

Anmo Wang¹,

Xuening Zhang¹,

Wenzuo Shang¹ and

Bo Wu¹^*

¹Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
²Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
³The Second Department of Neurology, Shanxi Provincial People's Hospital, Xi'an, China

Background: Neutrophils and albumin are associated with outcomes in patients with acute ischemic stroke (AIS). We aimed to explore the association between the neutrophil percentage-to-albumin ratio (NPAR), a novel marker of inflammation and oxidative stress, and the 3-month functional outcome in AIS patients with reperfusion therapy.

Methods: This single-center, retrospective cohort study consecutively enrolled AIS patients with reperfusion therapy. Neutrophils and albumin were collected on admission. The primary outcome was a poor functional outcome, which was defined as a modified Rankin scale score of 3–6 at 3 months.

Results: A total of 647 patients with AIS who received reperfusion therapy were analyzed. The mean age was 68.9 ± 13.9 years, and 358 (55.3%) of the patients were men. The median NPAR was 1.89 (interquartile range [IQR] 1.64–2.09). The percentage of patients with a 3-month poor functional outcome was 57.0% (369/647). NPAR was positively associated with a poor functional outcome (odds ratio [OR] 2.76, 95% CI: 1.52–5.03, p = 0.001). When patients were classified into tertiles, patients in the upper tertile (2.03–7.59) had a higher risk of poor outcome than patients in the lower tertile after adjusting for potential confounders (0.78–1.73) (OR 2.10, 95% CI: 1.28–3.42, p = 0.003). The risk of poor outcome increased with NPAR tertiles (p-trend = 0.003). The optimal cut-off value of the NPAR for predicting a poor outcome was 1.72, with a sensitivity of 0.75, and a specificity of 0.43.

Conclusion: Neutrophil percentage-to-albumin ratio was significantly associated with 3-month poor functional outcomes in patients with AIS who received reperfusion therapy.

Introduction

Reperfusion therapy has become the standard of care for patients with acute ischemic stroke (AIS) (1). However, approximately half of the patients with AIS suffer poor clinical outcomes after reperfusion therapy (2, 3). Inflammation and oxidative stress are two critical variables influencing the prognosis of patients with AIS after reperfusion therapy (4).

During the acute phase of AIS, neutrophils are the earliest inflammatory cells that are abundantly present in cerebral microvessels, and their subsequent release of reactive oxygen species (ROS) is thought to be the main cause of reperfusion injury after AIS (5–9). Some studies found that serum albumin played a key role in scavenging ROS (10, 11) and might exert an anti-inflammatory effect by inhibiting neutrophil spreading (12, 13). Neutrophils and albumin are associated with outcomes in patients with AIS (14–18).

The neutrophil percentage-to-albumin ratio (NPAR) is an emerging marker of inflammation and oxidative stress. The NPAR has been reported to have prognostic significance in patients with cancer, spinal cord injury, acute kidney injury, acute myocardial infarction, and cardiogenic shock (19–27). Recently, a retrospective study explored the association between NPAR and infection in patients with AIS (28). However, there is uncertainty regarding the association between NPAR and 3-month functional outcomes in AIS patients with reperfusion therapy. We hypothesized that NPAR may reflect the severity of inflammation and ROS damage in the acute phase of AIS. We sought to assess the association between NPAR and patient outcomes after reperfusion therapy.