Neutrophil-lymphocyte Ratio Predicts Post-thrombolysis Early Neurological Deterioration In Acute Ischemic Stroke Patients

Background and purpose: Stroke is one of leading causes of mortality and long-term morbidity in China.Intravenous thrombolysis(IVT)has become the standard treatment for acute ischemic stroke within 4.5 hours after symptoms onset.However,a fraction of patients would develop early neurological deterioration(END)after IVT.The aim of our study was to explore the utility of neutrophil–lymphocyte ratio(NLR)in predicting END.Methods: From October 2016 to March 2018,342 consecutive patients with thrombolytic therapy were prospectively enrolled in this study.Blood cell counts were sampled in stroke emergency room before IVT.END was defined as a National Institutes of Health Stroke Scale score increase of ? 4 points within 24 hours after IVT.Multiple regression analysis was used to investigate the potential risk factors of END.We also performed receiver operating characteristic curve analysis and nomogram analysis to assess the overall discriminative ability of the NLR in predicting END.Results: Of the 342 AIS patients with treatment of IVT,86(25.1%)participants were identified with END.Univariate logistic regression analysis demonstrated that patients with NLR in the third tertile,compared with the first tertile,were more likely to have END [odds ratio,9.783;95% confidence interval(CI),4.847–19.764;P = 0.001].The association remained significant even after controlled for potential confounders.Also,a cutoff value of 4.43 for NLR was detected in predicting END with a sensitivity of 70.9% and a specificity of 79.3%(area under curve,0.779;95% CI,0.731–0.822).Conclusions: This study showed that elevated level of NLR may predict post-thrombolysis END in ischemic stroke patients.The higher the level of NLR,the greater the likelihood of post-thrombolysis END in AIS patients.When NLR is higher than 4.43,the possibility of post-thrombolysis END is significantly increased.