Dataset Information

Association between neutrophil percentage-to-albumin ratio and 3-month functional outcome in acute ischemic stroke patients with reperfusion therapy.

ABSTRACT:

Background

Neutrophils and albumin are associated with outcomes in patients with acute ischemic stroke (AIS). We aimed to explore the association between the neutrophil percentage-to-albumin ratio (NPAR), a novel marker of inflammation and oxidative stress, and the 3-month functional outcome in AIS patients with reperfusion therapy.

Methods

This single-center, retrospective cohort study consecutively enrolled AIS patients with reperfusion therapy. Neutrophils and albumin were collected on admission. The primary outcome was a poor functional outcome, which was defined as a modified Rankin scale score of 3-6 at 3 months.

Results

A total of 647 patients with AIS who received reperfusion therapy were analyzed. The mean age was 68.9 ± 13.9 years, and 358 (55.3%) of the patients were men. The median NPAR was 1.89 (interquartile range [IQR] 1.64-2.09). The percentage of patients with a 3-month poor functional outcome was 57.0% (369/647). NPAR was positively associated with a poor functional outcome (odds ratio [OR] 2.76, 95% CI: 1.52-5.03, p = 0.001). When patients were classified into tertiles, patients in the upper tertile (2.03-7.59) had a higher risk of poor outcome than patients in the lower tertile after adjusting for potential confounders (0.78-1.73) (OR 2.10, 95% CI: 1.28-3.42, p = 0.003). The risk of poor outcome increased with NPAR tertiles (p-trend = 0.003). The optimal cut-off value of the NPAR for predicting a poor outcome was 1.72, with a sensitivity of 0.75, and a specificity of 0.43.

Conclusion

Neutrophil percentage-to-albumin ratio was significantly associated with 3-month poor functional outcomes in patients with AIS who received reperfusion therapy.

SUBMITTER: Cui T

PROVIDER: S-EPMC9513151 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Association between neutrophil percentage-to-albumin ratio and 3-month functional outcome in acute ischemic stroke patients with reperfusion therapy.

Cui Ting T Wang Changyi C Zhu Qiange Q Li Shucheng S Yang Yuan Y Wang Anmo A Zhang Xuening X Shang Wenzuo W Wu Bo B

Frontiers in neurology 20220913

<h4>Background</h4>Neutrophils and albumin are associated with outcomes in patients with acute ischemic stroke (AIS). We aimed to explore the association between the neutrophil percentage-to-albumin ratio (NPAR), a novel marker of inflammation and oxidative stress, and the 3-month functional outcome in AIS patients with reperfusion therapy.<h4>Methods</h4>This single-center, retrospective cohort study consecutively enrolled AIS patients with reperfusion therapy. Neutrophils and albumin were coll ...[more]

PMID: 36176549

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Project description:BackgroundThe prognostic role of the neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, in acute ischemic stroke (AIS) after reperfusion therapy remains controversial. Therefore, this meta-analysis sought to assess the correlation between the dynamic NLR and the clinical outcomes of patients with AIS after reperfusion therapy.MethodsPubMed, Web of Science, and Embase databases were searched to identify relevant literature from their inception to 27 October 2022. The clinical outcomes of interest included poor functional outcome (PFO) at 3 months, symptomatic intracerebral hemorrhage (sICH), and 3-month mortality. The NLR on admission (pre-treatment) and post-treatment was collected. The PFO was defined as a modified Rankin scale (mRS) of >2.ResultsA total of 17,232 patients in 52 studies were included in the meta-analysis. The admission NLR was higher in the 3-month PFO (standardized mean difference [SMD] = 0.46, 95% confidence interval [CI] = 0.35-0.57), sICH (SMD = 0.57, 95% CI = 0.30-0.85), and mortality at 3 months (SMD = 0.60, 95% CI = 0.34-0.87). An elevated admission NLR was associated with an increased risk of 3-month PFO (odds ratio [OR] = 1.13, 95% CI = 1.09-1.17), sICH (OR = 1.11, 95% CI = 1.06-1.16), and mortality at 3 months (OR = 1.13, 95% CI = 1.07-1.20). The post-treatment NLR was significantly higher in the 3-month PFO (SMD = 0.80, 95% CI = 0.62-0.99), sICH (SMD = 1.54, 95% CI = 0.97-2.10), and mortality at 3 months (SMD = 1.00, 95% CI = 0.31-1.69). An elevated post-treatment NLR was significantly associated with an increased risk of 3-month PFO (OR = 1.25, 95% CI = 1.16-1.35), sICH (OR = 1.14, 95% CI = 1.01-1.29), and mortality at 3 months (OR = 1.28, 95% CI = 1.09-1.50).ConclusionThe admission and post-treatment NLR can be used as cost-effective and easily available biomarkers to predict the 3-month PFO, sICH, and mortality at 3 months in patients with AIS treated with reperfusion therapy. The post-treatment NLR provides better predictive power than the admission NLR.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022366394.

Project description:BackgroundHemorrhagic transformation (HT) is a tragic complication of acute ischemic stroke (AIS), with spontaneous HT (sHT) occurring even without reperfusion therapies. Despite evidence suggesting that several inflammation biomarkers are closely related to HT, its utility in sHT risk stratification remains unclear. This study aimed to identify and integrate effective inflammatory biomarkers associated with sHT and to develop a novel nomogram model for the early detection of sHT.MethodsWe conducted a retrospective observational cohort study of AIS patients receiving conventional medical treatment solely from March 2022 to March 2023, using a prospectively maintained database. All patients underwent CT follow-up within 7 days after admission, with sHT occurrence within this period as the outcome. Data on demographics, clinical information, laboratory results, and imaging were collected. The cohort was divided into training and validation sets (7:3). Least absolute shrinkage and selection operator (LASSO) regression selected inflammatory biomarkers for a novel index. Univariable and multivariable logistic regressions were conducted to identify independent sHT risk factors. Receiver operating characteristic (ROC) analysis determined optimal cut-off values for continuous factors. A nomogram was developed and validated internally and externally. Predictive accuracy was assessed using the area under the ROC curve (AUC) and calibration plots. Decision curve analysis (DCA) evaluated clinical usefulness.ResultsOf 803 AIS patients, 325 were included in the final analysis. sHT was found in 9.5% (31 patients). Training (n = 228) and validation (n = 97) cohorts showed no significant demographic or clinical differences. LASSO regression integrated neutrophil-to-albumin ratio (NAR) and triglycerides (TGs) into a novel index-NATG. Independent sHT risk factors included baseline National Institute of Health Stroke Scale (NIHSS) (OR = 1.09, 95% CI (1.02, 1.16), p = 0.0095), NATG (OR = 1534.87, 95% CI (5.02, 469638.44), p = 0.0120), D-dimer (DD) (OR = 1.12, 95% CI (1.01, 1.25), p = 0.0249), and total cholesterol (TC) (OR = 1.01, 95% CI (1.00, 1.01), p = 0.0280), with their respective optimal cut-off values being 13, 0.059, 0.86, and 3.6. These factors were used to develop the nomogram in the training cohort, which achieved an AUC of 0.804 (95% CI, 0.643-0.918) in the training cohort and 0.713 (95% CI, 0.499-0.868) in the validation cohort, demonstrating consistent calibration. DCA confirmed the nomogram's clinical applicability in both cohorts.ConclusionsA novel indicator combining NAR and TG is positively associated with sHT in AIS patients. The constructed nomogram, integrating this novel indicator with other risk factors, provides a valuable tool for identifying sHT risk, aiding in clinical decision-making.

Project description:Background and Aims: Systemic inflammation is associated with an increased risk of cognitive impairment and dementia, but the associations between them in stroke patients are less clear. We examined the impact of systemic inflammation represented as the neutrophil-lymphocyte ratio (NLR) on the development of post-stroke cognitive impairment (PSCI) and domain-specific cognitive outcomes 3-month after ischemic stroke. Methods: Using prospective stroke registry data, we consecutively enrolled 345 participants with ischemic stroke whose cognitive functions were evaluated 3-month after stroke. Their cognition was assessed with the Korean version of the Vascular Cognitive Impairment Harmonization Standards and the Korean-Mini Mental Status Examination. PSCI was defined as a z-score of < -2 standard deviations for age, sex, and education adjusted means in at least one cognitive domain. The participants were categorized into five groups according to the quintiles of NLR (lowest NLR, Q1). The cross-sectional association between NLR and PSCI was assessed using multiple logistic regression, adjusting for age, sex, education, vascular risk factors, and stroke type. Results: A total of 345 patients were enrolled. The mean age was 63.0 years and the median NIHSS score and NLR were 2 [1-4] and 2.26 [1.65-2.91], respectively. PSCI was identified in 71 (20.6%) patients. NLR was a significant predictor for PSCI both as a continuous variable (adjusted OR, 1.14; 95% CI, 1.00-1.31) and as a categorical variable (Q5, adjusted OR, 3.26; 95% CI, 1.17-9.08). Patients in the Q5 group (NLR ≥ 3.80) showed significantly worse performance in global cognition and in visuospatial and memory domains. Conclusions: NLR in the acute stage of ischemic stroke was independently associated with PSCI at 3 months after stroke, and high NLR was specifically associated with cognitive dysfunction in the memory and visuospatial domains. Thus, systemic inflammation may be a modifiable risk factor that may influence cognitive outcomes after stroke.

Project description:(1) Background: Ischemic stroke is one of the leading causes of death and disability. An inflammatory response is observed in multiple stages of cerebral ischemia, particularly in the acute phase. Recent publications revealed that the neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) may be used to predict long-term prognosis in acute ischemic stroke (AIS) after thrombolysis. To test whether there is a relationship between the combination of these parameters and long-term prognosis, we analyzed the NLR-LMR combination in AIS patients treated with intravenous recombinant tissue plasminogen activator (rtPA); (2) Methods: The study included 285 adults with a diagnosis of AIS and rtPA treatment within a 4.5 h time window. Blood samples were obtained at admission and 24 h after thrombolysis to calculate pre- and post-thrombolysis NLR and LMR. Clinical data, including NIHSS was registered on admission and day 1. The long-term outcome was defined 90 days post-event by the modified Rankin Scale (mRS). Therapy-associated intracranial hemorrhage (ICH) was classified according to ECASS II. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs of NLR and LMR as predictors of therapy outcomes; (3) Results: Patients were stratified by cutoffs of 5.73 for NLR and 2.08 for LMR. The multivariate logistic regression model, including all possible confounders, displayed no significant association between NLR or LMR with 3-months functional prognosis. The combination of high NLR-low LMR vs. low NRL-high LMR as obtained 24 h after thrombolysis was found to be an independent predictor of poor 3-months functional outcome (mRS ≥ 2; OR 3.407, 95% CI 1.449 to 8.011, p = 0.005). The proportion of patients between low NLR-high LMR and high NLR-low LMR groups from admission to day 1 showed no significant change in the good outcome group. On the other hand, in the poor outcome group (mRS ≥ 2), low NLR-high LMR and high NLR-low LMR groups displayed a significant shift in patient proportions from 67% and 21% at admission (p = 0.001) to 36% and 49% at 24 h after thrombolysis (p < 0.001), respectively; (4) Conclusions: Our study demonstrated for the first time that a high NLR-low LMR combination as observed at 24 h after thrombolysis can serve as an independent predictor of 3-months poor outcome in AIS patients. This simple and readily available data may help clinicians to improve the prognostic estimation of patients and may provide guidance in selecting patients for personalized and intensified care post-thrombolysis.

Dataset Information

Association between neutrophil percentage-to-albumin ratio and 3-month functional outcome in acute ischemic stroke patients with reperfusion therapy.

Background

Methods

Results

Conclusion

Publications

Association between neutrophil percentage-to-albumin ratio and 3-month functional outcome in acute ischemic stroke patients with reperfusion therapy.

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