Correlation Of Neutrophil/Albumin Ratio And Outcomes In Patients With Acute Ischemic Stroke

Objective To investigate the association between the neutrophil/albumin ratio(NAR)and 3-month clinical outcome in patients with acute ischemic stroke(AIS)after treatment with recombinant tissue plasminogen activator(rt-PA).Methods This retrospective study analyzed patients with AIS undergoing intravenous thrombolysis with rt-PA between January 1,2017,and March 31,2020.Blood samples were obtained within 24 hours of admission.The primary outcome was defined as 3-month poor prognosis(mRS 3-6)and the secondary outcome was defined as 3-month all-cause death(mRS 6).Patients were divided into NAR tertile groups(NAR<0.114,n=80;0.114<NAR<0.155,n=81;NAR>0.155,n=80).Univariate and multifactorial logistic regression models were used to examine the association between NAR,and primary and secondary outcomes.Receiver operating characteristic(ROC)curve analysis and DeLong’s method were used to estimate the discrimination of the new model.Results A total of 241 patients with AIS who were eligible for inclusion were enrolled in the study.The differences between the three groups were statistically significant for age distribution(p=0.033),pre-thrombolysis NIHSS(p<0.001),24-hour post-thrombolysis NIHSS(p<0.001),7-day post-thrombolysis NIHSS(p<0.001),3-month mRS(p<0.001),and CT-ASPECTS score(p=0.011).Moreover,pre-thrombolysis NIHSS(r=0.335,p<0.001),24-hour post-thrombolysis NIHSS(p=0.502,p<0.001),7-day post-thrombolysis NIHSS(r=0.436,p<0.001)and 3-month mRS(r=0.507,p<0.001)were positively correlated with NAR.After adjustment for potential confounders,high NAR remained an independent risk factor for the primary outcome(OR=8.807,95%CI[3.570-21.727],p<0.001)but not for the secondary outcome(OR=0.984,95%CI[0.180-5.364],p=0.985).The area under the ROC curve of NAR was significantly different from PLR and MLR(0.812:0.597,p<0.001;0.812:0.661.p=0.004)and its prediction was more accurate.Similarly,the NAR had good predictive ability for both cardio-embolism and large artery atherosclerosis stroke.Furthermore,after adjustment for confounders,NAR had good predictive performance in subgroup analyses stratified by gender,age,BMI,history of smoking,history of alcohol consumption,atrial fibrillation,and stroke subtype.Conclusion Higher NAR within 24 hours of admission may be an independent predictor of 3-month poor prognosis in patients with AIS after intravenous thrombolysis,but is not associated with 3-month all-cause death.