| Objective:To investigate the influence and predictive value of LMR on prognosis of patients with AIS and patients treated with thrombolysis in super-early stage.Methods:A total of 620 patients with AIS admitted to Department of Neurology at the Affiliated Hospital of Chengde Medical University,were recruited retrospectively between January 2015 and April 2017.The median age was 61.0(54.0-73.0),and 390 of all patients(62.9%)were male while 230 of them(37.1%)were female.Among all eligible patients,a total of 180 patients received IV rt-PA(alteplase)therapy with a standard dose of 0.9mg/kg(maximum 90mg)during the treatment time window of 4.5h.All the patients met the guidelines for the diagnosis and treatment of acute ischemic stroke regarding diagnostic criteria and thrombolysis treatment of AIS.LMR was calculated according to lymphocyte count and monocyte count on admission.Based on LMR on admission(>4.79,2.86-4.79,<2.86),patients with AIS were divided into group A,group B and group C.The differences of the baseline characteristics were compared among 3 groups.Patients treated with thrombolytic therapy were classified into group a,group b,and group c according to LMR on admission(>4.34,2.79-4.34,<2.79).The differences of the baseline characteristics were compared among 3 groups.Moderate to severe stroke was defined as a National Institute of Health Stroke Scale(NIHSS)score of 6 or higher.Poor outcome at 3 months was defined as a modified Rankin Scale score of 3 or higher.We used Spearman rank correlation to evaluate the relationship between LMR and stroke severity.Binary logistic regression analysis was used to assess risk factors of stroke severity and prognosis.The receiver operating characteristic curve(ROC)was used to estimate the predictive value of LMR on prognosis.Results:1.Age,NIHSS score on admission,fasting blood glucose(FBG)level,incidence of coronary heart disease(CHD)and monocyte counts in group C were significantly higher than other 2 groups(P<0.05);The patients in group A and B had a significantly higher level of total cholesterol(TC),triglyceride(TG)and incidence of hyperlipidemia than those in group C(P<0.05);The levels of lymphocytes and LMR in group A were significantly much higher than those in the other 2 groups(P<0.05);The levels of lymphocytes in group B were higher than that in group C,and the monocyte counts and percentage of male patients in group B were significantly higher than those in group A(P<0.05).2.The moderate to severe stroke rate and the poor outcome rate at 3-months in group C were significantly higher than those in the other 2 groups(P<0.05);Patients with moderate to severe strokes or mild strokes suffering poor outcome in group C were significantly much more than those in the other 2 groups(P<0.05);Patients treated by IV rt-PA in group C had a higher percentage of poor outcome than those in the other 2 groups(P<0.05);Patients treated with thrombolysis in group B were more likely to suffer poor prognosis compared with group A(P<0.05);3.The LMR level was negatively correlated with the NIHSS score on admission(r=-0.146,P<0.05);4.The results of the binary logistic regression analysis indicated that higher LMR was an independent protective factor of stroke severity(odds ratio [OR] =0.879,95% confidence interval [CI] 0.812-0.952,P=0.001)and prognosis(OR=0.545,95% CI 0.479-0.620,P<0.05);Increased lymphocytes independently contributed to a favorable outcome(OR=0.315,95% CI 0.226-0.440,P<0.05)while higher monocyte counts were independently associated with poor outcome(OR=1.530,95% CI 1.368-1.712,P<0.05);5.The ROC curve showed that the optimal critical value of the LMR level was 3.55.Its sensitivity was 76.9% and the specificity was 76.2%(area under the curve: 0.814,95% CI 0.777-0.850,P<0.05);6.Age,NIHSS score on admission,monocyte counts and percentage of atrial fibrillation in group c were significantly higher than other 2 groups(P<0.05);TG concentration,lymphocyte counts and LMR values in group c were significantly lower compared with the other 2 groups(P<0.05);Lymphocyte counts in group b were significantly lower than that in group a,whereas monocyte counts were higher than that in group a(P<0.05).The remainder of baseline data among subgroups showed no significant difference(P>0.05);7.Patients with lower LMR values in group c had more moderate to severe strokes and higher mRS scores than those in the other 2 groups(P<0.05);Patients in group c with higher LMR who had either moderate ot severe stroke or mild stroke were more likely to suffer poor outcome(P<0.05);Patients treated with thrombolysis in group b suffering poor prognosis were significantly more than group a(P<0.05);Compared with the other 2 groups,incidence of symptomatic intracranial hemorrhage(sICH)after thrombolysis in group c also was remarkably higher(P=0.027);8.The results of the binary logistic regression analysis indicated that higher LMR value was an independent protective factor against adverse prognosis(OR=0.683,95% CI 0.490-.952,P = 0.024);9.The ROC suggested a moderate sensitivity(71.6%)and specificity(80.5%)of LMR for predicting prognosis with an optimal cut-off point at 3.48(area under the curve: 0.767,95% CI 0.674-0.859,P<0.05).Conclusions:1.LMR value on admission is inversely correlated with stroke severity;2.A lower LMR on admission is independently associated with severe stroke in patients with AIS;3.A lower LMR on admission is an independent risk factor of 3-month poor outcome in AIS and patients treated with thrombolytic therapy;4.LMR level on admission possesses good predictive value of prognosis for AIS and patients treated with thrombolytic therapy. |
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