Deans' stroke musings: Day 3 neutrophil-to-lymphocyte ratio and its derived indices predict 90-day poor outcomes following mechanical thrombectomy in acute ischemic stroke patients

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.

Wednesday, February 12, 2025

Day 3 neutrophil-to-lymphocyte ratio and its derived indices predict 90-day poor outcomes following mechanical thrombectomy in acute ischemic stroke patients

This doesn't get survivors recovered, does it? So useless research!

Day 3 neutrophil-to-lymphocyte ratio and its derived indices predict 90-day poor outcomes following mechanical thrombectomy in acute ischemic stroke patients

Weiwei Gao¹^†

Arslan Annadurdyyev¹^†

Lingfeng Yu²

Rong Huang¹

Bin Liu²

Yixiong Lin³

Huaiyi Li⁴

Renjing Zhu¹^*

¹Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
²School of Medicine, Xiamen University, Xiamen, China
³Department of Cardiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
⁴Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China

Objective: 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.

Methods: 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.

Results: 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 (n = 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, p < 0.001); for dNLR, it increased by 104% (OR = 2.04, 95% CI: 1.73–2.40, p < 0.001); and for NMLR, it increased by 35% (OR = 1.35, 95% CI: 1.26–1.45, p < 0.001).

Conclusion: 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.

1 Introduction

Acute ischemic stroke (AIS) is a leading cause of mortality and disability worldwide. According to statistics from the World Health Organization, approximately 12 million new stroke cases occur globally each year, with ischemic strokes accounting for a staggering 62.4%, resulting in nearly 6 million deaths or severe disabilities (1). Large vessel occlusion (LVO) strokes constitute one-third of AIS cases and often present with significant neurological impairments and poorer prognoses (2).

In recent years, mechanical thrombectomy (MT) has emerged as the standard treatment for LVO patients because of its remarkable clinical benefits (3). Compared with intravenous thrombolysis alone, MT significantly improves functional outcomes and reduces mortality and disability rate (4). However, despite advancements in MT techniques, a considerable proportion of patients still experience unfavorable outcomes. A prospective study revealed that among LVO patients undergoing MT, only 49% reached functional independence (defined as a modified Rankin Scale score [mRS] ≤ 2) at 90 days (5). Poor outcomes not only increase the burden on patients and their families but also place substantial pressure on society and healthcare systems. Therefore, identifying key factors influencing MT outcomes is crucial for early recognition of high-risk patients and optimization of clinical management strategies.

Inflammatory responses play a pivotal role in the occurrence, progression, and prognosis of AIS (6). Ischemic brain injury rapidly activates the innate immune responses, leading to the release and recruitment of inflammatory cells and mediators, which further exacerbates brain tissue damage and disrupts blood–brain barrier (BBB) integrity (7). The neutrophil-to-lymphocyte ratio (NLR), an emerging inflammatory marker in peripheral blood, has been shown to be closely associated with the prognosis of AIS patients (8, 9). However, previous studies have primarily focused on baseline levels or single measurements of the NLR, and a systematic evaluation of its dynamic changes and prognostic value is lacking.

Furthermore, the derived neutrophil-to-lymphocyte ratio (dNLR) and neutrophil-monocyte-to-lymphocyte ratio (NMLR), which are derived indices of the NLR, have demonstrated significant prognostic predictive value in various inflammatory and immune diseases (10, 11) as well as acute myocardial infarction (12). Nevertheless, the clinical utility of these novel inflammatory markers in AIS patients has not been fully validated, and whether their predictive performance is superior to that of the traditional NLR remains to be elucidated.

Given this background, we conducted this retrospective cohort study to investigate the dynamic changes in NLR and its derived indices following MT in AIS patients and evaluate their prognostic predictive value. By systematically assessing the dynamic changes in peripheral immune markers, this study aimed to provide new clinical insights into prognostic assessment for AIS patients and evidence-based guidance for individualized treatment strategies.

e at link. Mother