Correlative Study Of NLR And PLR Before Intravenous Thrombolysis With Early Neurological Deterioration And Prognosis In Acute Ischemic Stroke

Objective To explore the correlation of neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)before intravenous alteplase thrombolysis with Early Neurological Deterioration(END)and long-term prognosis in patients with acute ischemic stroke(AIS).Method This retrospective study included 105 patients with AIS who met the inclusion criteria that visited our hospital from January 2017 to August 2019,and corresponding contraindications were excluded.Neutrophil count,lymphocyte count,platelet count and other relevant indicators before intravenous thrombolysis were recorded and NLR and PLR values were calculated.All patients were divided into END group and non-END group according to whether early neurological deterioration occurred.The National Institute of Health Stroke Scale(NIHSS)before and after treatment,24 hours were compared between the two groups,and the causes of neurological deterioration were recorded.And observe the cause of neurological deterioration.At the same time,the patients were divided into the group with good prognosis and the group with poor prognosis according to the Modified Rankin Scale(m RS)of 90 days.The single factor analysis and binary logistic regression analysis respectively were used to investigate the correlation of NLR and PLR before intravenous thrombolysis with Early Neurological Deterioration and long-term prognosis in patients with acute ischemic stroke in order to clarify the predictive value of them.Result1.This study included 105 patients with AIS,including 14 in the END group and91 in the non-END group.The age,neutrophil count,PLR,and onset to treatment duration in the END group were all higher than those in the non-END group,and the lymphocyte counts were lower than those in the non-END group,with significant differences(P<0.05).PLR(OR: 1.01,95% CI: 1.00-1.02)and onset to treatment duration(OR: 1.02,95% CI: 1.00-1.03)were independent predictors of END after intravenous thrombolysis.Among the laboratory results for predicting the occurrence of early neurological deterioration,PLR has the highest accuracy and sensitivity in predicting prognosis.The area under the ROC curve is 0.749(95% CI: 0.620-0.877),and the corresponding sensitivity is 85.7%;The most specific was neutrophil count(79.1%).2.During the 3 months follow-up,73 patients with good prognosis(m RS≤2)and32 patients with poor prognosis(m RS>2)were included.The age,the prevalence of hypertension,white blood cell count,neutrophil count,platelet count,NLR,PLR,NIHSS at admission,and onset to treatment duration in the poor prognosis group were higher than those with good prognosis.The differences between the groups were statistically significant(P<0.05).NLR(OR: 2.71,95% CI: 1.35-5.44),white blood cell count(OR: 3.14,95% CI: 1.03-9.57),and NIHSS at admission(OR: 1.29,95% CI:1.12-1.49)were independent predictors of the long-term prognosis after intravenous thrombolysis.In the analysis of predicting long-term prognosis,the highest accuracy and sensitivity is PLR,the area under the ROC curve is 0.699(95% CI: 0.594-0.805),the sensitivity is 71.9%,and the most specific indicator is neutrophil count(86.3%).At the same time,compared with the single factor analysis,the accuracy of the prognosis of the combined NLR and PLR is improved,and the area under the ROC curve is 0.701(95% CI: 0.591-0.812).Conclusion1.High lymphocyte count is a protective factor for early neurological deterioration after intravenous thrombolysis in patients with AIS.PLR is an independent predictor of early neurological deterioration and NLR is an independent predictor of long-term prognosis.2.Combining non-invasive indicators such as NLR and PLR can improve the predictive efficacy of the prognosis in AIS patients of intravenous thrombolysis.