Postoperative neutrophil-to-lymphocyte ratio predicts malignant cerebral edema following endovascular treatment for acute ischemic stroke

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Postoperative neutrophil-to-lymphocyte ratio predicts malignant cerebral edema following endovascular treatment for acute ischemic stroke

Sujie Zheng¹Xinzhao Jiang²Shunyuan Guo^2*Zongjie Shi^2*

• ¹Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
• ²Department of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China

Background and purpose: Malignant cerebral edema (MCE) is one of serious complications with high mortality following endovascular treatment (EVT) for acute ischemic stroke (AIS) with large vessel occlusion. We aimed to investigate the relationship between postoperative neutrophil-to-lymphocyte ratio (NLR) and MCE after EVT.

Methods: The clinical and imaging data of 175 patients with AIS of anterior circulation after EVT were studied. Admission and postoperative NLR were determined. The presence of MCE was evaluated on the computed tomography performed 24 h following EVT. The clinical outcomes were measured using the modified Rankin Scale (mRS) at 90-day after onset. Univariate and multivariate regression analyses were used to analyze the relationship between postoperative NLR and MCE. Optimal cutoff values of postoperative NLR to predict MCE were defined using receiver operating characteristic analysis.

Results: MCE was observed in 24% of the patients who underwent EVT and was associated with a lower rate of favorable clinical outcomes at 90-day. Multivariate logistic regression analysis demonstrated that baseline Alberta Stroke Program Early CT Score (ASPECT) score (OR = 0.614, 95% CI 0.502–0.750, p = 0.001), serum glucose (OR = 1.181, 95% CI 1.015–1.374, p = 0.031), and postoperative NLR (OR = 1.043, 95% CI 1.002–1.086, p = 0.041) were independently associated with MCE following EVT for AIS with large vessel occlusion. Postoperative NLR had an area under the receiver operating characteristic curve of 0.743 for prediction MCE, and the optimal cutoff value was 6.15, with a sensitivity and specificity of 86.8% and 55%.

Conclusion: Elevated postoperative NLR is independently associated with malignant brain edema following EVT for AIS with large vessel occlusion, and may serve as an early predictive indicator for MCE after EVT.

Introduction

Malignant cerebral edema (MCE) is one of common complications with high mortality following endovascular treatment (EVT) for acute ischemic stroke (AIS) with large vessel occlusion. The mechanism and development of cerebral edema are complex, and identifying factors that influence its formation and exploring early predictive markers are of significant clinical importance for preventing the development of MCE and improving clinical outcomes.

Previous research on predicting cerebral edema after stroke has largely focused on clinical characteristics and imaging indicators, such decreased level of consciousness, nausea or vomiting, and heavy smoking, age, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline ASPECT score, collateral circulation score (1, 2). However, these indicators do not fully reflect the mechanisms underlying the development of cerebral edema. In recent years, the neutrophil-to-lymphocyte ratio (NLR), a biomarker reflecting the pathophysiological mechanisms of stroke, has been shown to be a valuable tool for predicting stroke prognosis. Brooks et al. (3) reported a significant correlation between NLR and clinical outcomes following EVT, elevated admission NLR being associated with poor outcomes and mortality. Goyal et al. (4) demonstrated a significant correlation between lower admission NLR and favorable outcomes and functional independence at 3 months for AIS patients. However, it remains unclear whether the NLR, as an inflammatory biomarker, is involved in the development of cerebral edema and whether it can serve as an early predictive marker for MCE following EVT for AIS with large vessel occlusion.

Therefore, this study aims to explore the relationship between NLR and malignant cerebral edema following endovascular treatment for AIS with large vessel occlusion.