Correlation Between Neutrophil Count And Prognosis Of Acute Cerebral Infarction Before Intravenous Thrombolysis

Background and objectiveStroke is the leading cause of death among human beings.Acute cerebral infarction or Acute ischemic stroke(AIS),which accounts for approximately 69.6%~79.8% of stroke,is the most common type of stroke,and is characterized by a high recurrence rate,high disability rate,and death rate.Not only is the incidence high,but the disease is beginning to affect younger and younger individuals,which seriously endangers human health and affects the quality of human life.At present,the most effective measure for the treatment of acute cerebral infarction and the recovery of blood flow is intravenous thrombolysis,as well as the establishment of stroke units,advanced stroke centers,and stroke maps,in order to save the ischemic penumbra faster and more effectively,and improve the quality of life of patients.However,the most severe complication accompanying intravenous thrombolysis is intracranial hemorrhaging.If hemorrhagic transformation occurs following thrombolysis,the prognosis of the patient is often poor.Whether or not the risk of hemorrhagic transformation can be predicted,the pros and cons of patients can be evaluated and weighed strictly,and the choice of more suitable intravenous thrombolysis recipients can be determined,has become the main focus of attention.Those patients with acute cerebral infarction who entered the green channel of the emergency stroke department at our hospital first completed routine blood tests,blood coagulation,kidney function,and levels of electrolytes,and myocardial enzymes.Next,patients’ brain CT were performed to exclude intracranial hemorrhaging,recombinant tissue plasminogen activator(rt-PA)was administered with the signed informed consent of patients and their family members.Neutrophil count,a subtype of white blood cells and indicative of inflammatory factors,was measured and monitored before treatment.In addition,Neutrophil to Lymphocyte Ratio(NLR),a new inflammatory marker proven to be related to the prognosis of ischemic stroke and hemorrhagic stroke was calculated,in order to determine whether or not it correlates with the prognosis of patients after intravenous thrombolysis,especially following the occurrence of symptomatic intracranial hemorrhage.This study was designed to investigate whether there is a correlation between neutrophil count,NLR,and prognosis in patients with AIS before intravenous thrombolysis.MethodsThree hundred and seventy-two patients with acute ischemic stroke treated by intravenous thrombolysis with rt-PA were collected from the Fifth Affiliated Hospital of Zhengzhou University and the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2018.Next patients were subjected to routine blood tests prior to intravenous thrombolysis,while cranial imaging was performed to excluded the presence of intracranial hemorrhaging.Neutrophil count,white blood cell count,neutrophil to lymphocyte ratio(NLR),demographic characteristics,past medical history,personal history,and time from onset to blood sample collection were also recorded during admission.According to the National Institute of Health Stroke Scale(NIHSS)score,the degree of neurological impairment was assessed.NIHSS score < 8 was defined as the mild stroke group and > 8 as the moderate to severe stroke group.Based on the cranial imagining results,the occurrence of hemorrhagic transformation(HT)following intravenous thrombolysis was determined,and patients were divided into either HT group or non-HT group.Modified mRS scores,which assess the daily living ability of patients was determined.HT was defined as the primary endpoint event after thrombolysis,with a good prognosis defined as mRS score of less than or equal to 2,a poor prognosis defined as mRS score between 2 and 5,and death defined as mRS score of 6 as the secondary endpoint event.NIHSS scores and mRS scores were assessed by two specially trained physicians and averaged together.SPSS23.0 software was used for data processing.Multi-factor logistic regression analysis was used to calculate odds ratio(OR)and 95% confidence interval(95% CI).The factors affecting the prognosis of AIS thrombolysis were determined.The receiver operating characteristic(ROC)curve was used to analyze the prognostic value of neutrophils and NLR for HT and 90 d prognosis.Results1.Both neutrophils(7.42±2.61 vs 6.09±2.79,P=0.021)and NLR(6.36±4.37 vs 4.26±2.45,P=0.008)was higher among patients with HT than non-HT subject.It was also found that neutrophils(OR=1.634,95% CI: 1.277-1.895,P=0.005)and NLR(OR=2.038,95% CI: 1.643-5.159,P=0.001)were reliable predictors of HT following thrombolysis.2.ROC curve analysis of HT after AIS intravenous thrombolysis showed that the area under the NLR curve was 0.730(95% CI: 0.631-0.789),which was better than white blood cells 0.615(95% CI: 0.531-0.699),neutrophils 0.654(95% CI: 0.574-0.734).The optimal cutoff value was 5.91.The sensitivity was 78.0% and the specificity was 71.9%.3.ROC curve analysis 90 days after AIS intravenous thrombolysis showed that white blood cells(the area of curve was 0.549,0.413,0.525),neutrophils(the area of curve was 0.564,0.517,0.548)and NLR(the area of curve was 0.626,0.592,0.586)had certain predictive values.Conclusion1.NLR before AIS intravenous thrombolysis can predict HT occurrence after thrombolysis well,which is superior to the predictive value of neutrophil and white blood cell count.2.Neutrophils,NLR and white blood cells before intravenous thrombolysis of AIS patients have certain predictive value for the prognosis at 90 days following thrombolysis,but the diagnostic efficiency is not high.