Correlation Between NLR And Hemorrhage Transformation In Acute Ischemic Cerebral Infarction

Background and objective:previous studies indicated that the neutrophil-tolymphocyte ratio(NLR)was related to acute ischemic cerebral infarction(AIS)and Hemorrhagic Transformation(HT)after reperfusion treatment,but there is little evidence on whether NLR is associated with the risk of spontaneous HT after AIS.The purpose of this study was to investigate the relationship between NLR and hemorrhagic transformation in ischemic stroke patients without reperfusion therapy.To further clarify the effect of leukocyte subtypes on hemorrhagic transformation.To provide new serological indicators for the early detection of HT,it is helpful to identify the high-risk population of HT in ischemic stroke,so as to select more appropriate treatment for acute stroke patients.Methods:The study group consisted of the Patients admittded within seven days after stroke onset from the Department of the First Affiliated Hospital of Guangxi Medical University between January 2013 to January 2018.The laboratory data were collected within 24 hours after admission.HT was defined as hemorrhage presented on follow-up magnetic resonance imaging or computed tomography(CT)but not on baseline CT.patients were divided into HT groupand non-HT group according to whether Hemorrhagic Transformation occurred at admission.The univariate analysis and Binary logistic regression were performed to assess the association of neutrophil-tolymphocyte ratio(NLR)and other indicators with HT.The Receiver Operating Characteristic(ROC)curves were used to test predictive power of leukocyte indicators for HT.Result:We included 202 patients with acute ischemic cerebral infarction,48 in HT group and 154 in non-HT group.Using univariate analysis,we found that there was a significant difference between the HT and non-HT group(P < 0.05)in the level of infarct size,atrial fibrillation,NLR,white blood cell count,neutrophil count,lymphocyte count,eosinophil count and alkaline phosphatase(P <.05).2.logistic regression analysis indicated that infarct size([OR] = 5.272,95% confidence interval [CI] = 2.16-12.89,P=0.000),atrial fibrillation([OR] =6.228,95% confidence interval [CI] =1.98-19.63,P=0.002,and level of lymphocyte count([OR]0.46,95% confidence interval [CI] =0.22-0.95,P=0.036),neutrophil count([OR]=1.303,95% confidence interval [CI] =1.03-1.65,P=0.026),NLR([OR]=1.406,95% confidence interval [CI] =1.12-1.77,P=0.003)are the independent risk factors of HT.3.Comparing the predictive ability of leukocyte indicators to HT after acute cerebral infarction by Receiver Operating Characteristic:NLR(area under curve [AUC] 0.77,95%CI 0.69-0.86,P<0.01);neutrophil(area under curve [AUC] 0.71,95%CI 0.62-0.80,P<0.01);lymphocyte count(area under curve [AUC] 0.73,95%CI 0.64-0.81,P<0.01).4.The logistic regression analysis was performed again with the same independent variables in the previous models,except for values of leukocyte indicators,which were included as a binary variables dichotomized according to the optimal cutoff value.The results suggested that high NLR and neutrophil count and Low levels of lymphocyte counts were independent predictors of HT.Conclusion:This study found that,high levels of NLR ? neutrophil count and Low levels of lymphocyte count are independent predictors of HT in patients with AIS who have not received reperfusion therapy,moreover NLR has higher diagnostic value.In addition,consistent with previous studies,massive infarction and atrial fibrillation are important risk factors for HT in patients with acute cerebral infarction.