Correlation Between Platelet To Lymphocyte Ratio At 24 Hours After Thrombolysis And 3-month Prognosis In Patients With Ischemic Stroke

Background: Acute ischemic stroke is the most predominant type of stroke and one of the most common causes of death and disability worldwide.According to statistics,there are3.94 million new stroke cases each year in China,which has become the country with the most number of stroke patients in the world.Stroke places a heavy burden on our national economy.Although emergency alteplase intravenous thrombolysis within 4.5 hours has become the standard of care for stroke,the overall prognosis for stroke patients is still relatively poor.Platelet to Lymphocyte Ratio(PLR),which refers to the ratio of absolute peripheral blood platelet count to lymphocytes,is an important clinical indicator of the systemic inflammatory response and may be closely related to poor prognosis in ischemic stroke.However,it is uncertain whether PLR also has a predictive value for the prognosis of patients receiving intravenous thrombolysis.Objective: The aim of this study was to clarify the trend of PLR before and 24 hours after thrombolysis and the correlation between Platelet to Lymphocyte Ratio at 24 hours after thrombolysis and 3-month prognosis in patients with ischemic stroke.Study methods: This study included 911 patients with acute ischemic stroke who received 0.9 mg/kg rt-PA intravenous thrombolysis in the green channel for stroke at the First Hospital of Jilin University from April 2015 to September 2022 on a continuous basis.We collected patients’ personal information,past medical history,and platelet/lymphocyte ratio(PLR)at baseline and 24 hours post-thrombolysis.Stroke outcome and whether death occurred were assessed at 3 months using the modified Rankin Scale(m-RS).All patients were randomized into the training and validation groups in a 3:1 ratio to compare whether there were differences in each clinical index between the two groups.Univariate and multivariate logistic regression was performed on the training group to clarify the relationship between PLR and patients’ prognosis and death at 3 months.The results of multivariate logistic regression in the training group were used to construct a nomogram for predicting adverse outcomes;the validation group was used to test the prognostic model.Results: Of the 911 patients,319 patients(35%)had a poor prognosis(m-RS > 2 score)and 46(5%)died.In the poor prognosis(m-RS > 2)group,the platelet lymphocyte ratio(PLR)at 24 hours of rt-PA treatment increased compared to pre-thrombolysis,but was not statistically significant(median: 121.4 vs 133.1,P = 0.096).In the good prognosis group,the 24-hour PLR was significantly lower after rt-PA treatment compared with the baseline PLR(median:119.3 vs.111.2,P < 0.001).Multifactorial logistic regression showed that 24-hour PLR after thrombolysis was independently associated with an increased risk of adverse outcomes(OR =1.006;95% confidence interval 1.002-1.009;P = 0.001)and 24-hour PLR after thrombolysis was independently associated with an increased risk of death(OR = 1.008,95% confidence interval 1.004-1.012.P = 0.000).The individualized prediction model for 3-month adverse outcomes in patients with acute ischemic stroke plotted based on multivariate logistic results in the training group showed good discriminatory power,with an area under the curve of 0.729 and 0.676 in the training and validation groups,respectively.The DCA curve results indicate the good predictive value of the 3-month adverse prediction model for thrombolysis with 24-hour PLR at thrombolysis as the main indicator.Conclusions:(1)The platelet/lymphocyte ratio at 24 hours after intravenous thrombolysis was independently associated with 3-month adverse outcomes and death in patients undergoing intravenous thrombolysis;whereas the baseline platelet/lymphocyte ratio at intravenous thrombolysis was not associated with an increased risk of adverse prognosis and death in patients.(2)The trend of increasing platelet/lymphocyte ratio over time is an important predictor of adverse outcomes in patients undergoing intravenous thrombolysis.(3)The platelet/lymphocyte ratio at 24 hours after thrombolysis in patients with intravenous thrombolysis may be a clinically feasible target for intervention to improve patient prognosis.