Perioperative NLR can predict the clinical prognosis of patients with acute anterior circulation large vessel occlusive stroke after thrombectomy

doi:10.3877/cma.j.issn.2095-5782.2022.04.010

Abstract

Abstract:

Objective

To investigate the relationship between the clinical prognosis of acute ischemic stroke patients with anterior circulation large vessel occlusion treated with thrombectomy and neutrophils to lymphocyte ratio (NLR) at admission, NLR 3-7 days after operation and the changes of perioperative NLR.

Methods

This study retrospectively analyze the patients with anterior circulation large vessel occlusive acute ischemic stroke who underwent thrombectomy in Zhengzhou University People's Hospital from January 2018 to June 2021. The baseline data, clinical manifestations and operation related indexes were collected. The patients were divided into good clinical prognosis group and poor clinical prognosis group according to the modified Rankin scale score 90 days after operation, NLR at admission was defined as NLR1, NLR at 3-7 days after operation was defined as NLR2, and NLR2-NLR1 was defined as the change of perioperative NLR. The factors with P < 0.05 in univariate analysis were included in logistic multivariate regression analysis to explore the relationship between NLR1, NLR2 and perioperative NLR and clinical prognosis, and to explore whether these indicators can predict the clinical prognosis.

Results

A total of 332 patients with anterior circulation large vessel occlusive AIS treated with MT were included in this study, of which 268 (80.7%) achieved successful reperfusion. At the 90 day follow-up, 147 (44.3%) patients had a good clinical prognosis. Univariate analysis showed that lower NLR2 and smaller perioperative NLR changes were significantly associated with clinical prognosis, successful reperfusion, symptomatic intracranial hemorrhage (sICH) and mortality at 90 day follow-up (P < 0.05). Multivariate logistic analysis showed that age (OR: 1.063, 95%CI: 1.034-1.092, P < 0.001), collateral circulation (OR: 0.454, 95%CI: 0.249-0.829, P = 0.01), first reperfusion (OR: 0.318, 95%CI: 0.172 -0.589, P < 0.001) and perioperative NLR changes (OR: 2.474, 95%CI: 1.964-3.117, P < 0.001) were independent predictors of clinical prognosis. Receiver Operating Characteristic Curve showed that when the cut-off value of perioperative NLR change was 3.42, the sensitivity and specificity of predicting clinical prognosis were 81.1% and 74.1% respectively.

Conclusions

NLR2 and the change of perioperative NLR are associated with successful reperfusion, sICH and mortality, and the changes of perioperative NLR is an independent predictor of good clinical prognosis.

Key words: Anterior circulation large vessel occlusion, Acute ischemic stroke, Mechanical thrombectomy, Neutrophil to Lymphocyte Ratio, Clinical prognosis

Feng Lin, Hongyun Zhang, Yingkun He, Tianxiao Li. Perioperative NLR can predict the clinical prognosis of patients with acute anterior circulation large vessel occlusive stroke after thrombectomy[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(04): 396-403.

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References 31

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		预后良好组（n = 147）	预后不良组（n = 185）	检验值	P值
年龄（±s）		61.05 ± 11.94	71.19 ± 10.30	-8.299	< 0.001
女性[n（%）]		75（51.0）	96（51.9）	0.025	0.875
既往卒中史[n（%）]		49（33.3）	75（40.5）	1.818	0.178
高血压		75（51.0）	116（62.7）	4.575	0.032
糖尿病		33（22.4）	40（21.6）	0.033	0.875
心房颤动		31（21.1）	60（32.4）	5.298	0.021
侧支循环[n（%）]				10.868	< 0.001
	良好	79（53.7）	66（35.7）
	不良	68（46.3）	119（64.3）
术前Mrs 0~2 [n（%）]		51（34.7）	55（29.7）	0.929	0.335
NIHSS [M（Q₁，Q₃）]		16（15，17）	15（14，17）	-0.713	0.476
ASPECTS [M（Q₁，Q₃）]		9（8，10）	9（8，9）	-2.227	0.026
溶栓史[n（%）]		33（22.4）	42（22.7）	0.003	0.956
核心梗死体积（n = 14）[M（Q₁，Q₃）]		34.5（17.25，44.75）	69（42.5，104）	-1.034	0.301
发病到穿刺时间[M（Q₁，Q₃）]		324（282，421）	328（255.5，447）	-0.434	0.664
穿刺到再通时间[M（Q₁，Q₃）]		125（100，170）	136（95，180）	-0.741	0.458
闭塞部位[n（%）]				5.249	0.154
	ICA	59（40.1）	88（47.6）
	MCA M1	69（47.0）	79（42.7）
	MCA M2	19（12.9）	18（9.7）
取栓方式[n（%）]				1.776	0.620
	血栓抽吸	33（22.4）	48（25.9）
	支架取栓	71（48.3）	86（46.5）
	中间导管辅助取栓	23（15.6）	33（17.8）
	支撑导管辅助支架取栓	20（13.6）	18（9.7）
取栓装置操作次数[M（Q₁，Q₃）]		1（1，2）	2（1，3）	-4.853	< 0.001
FPR [n（%）]		91（61.9）	65（35.1）	23.565	< 0.001
mTICI≥2B [n（%）]		132（89.8）	136（73.5）	13.956	< 0.001
sICH [n（%）]		6（4.1）	30（16.2）	12.476	0.001
90 d死亡[n（%）]		0（0）	16（8.6）	11.566^a	0.001
NLR1[M（Q₁，Q₃）]		3.90（3.09，4.87）	4.08（3.19，4.96）	-0.523	0.601
NLR2[M（Q₁，Q₃）]		6.51（5.35，7.99）	8.91（7.45，10.29）	-8.819	< 0.001
∆NLR[M（Q₁，Q₃）]		2.45（1.64，3.53）	4.61（3.67，5.68）	-10.794	< 0.001

		预后良好组（n = 147）	预后不良组（n = 185）	检验值	P值
年龄（±s）		61.05 ± 11.94	71.19 ± 10.30	-8.299	< 0.001
女性[n（%）]		75（51.0）	96（51.9）	0.025	0.875
既往卒中史[n（%）]		49（33.3）	75（40.5）	1.818	0.178
高血压		75（51.0）	116（62.7）	4.575	0.032
糖尿病		33（22.4）	40（21.6）	0.033	0.875
心房颤动		31（21.1）	60（32.4）	5.298	0.021
侧支循环[n（%）]				10.868	< 0.001
	良好	79（53.7）	66（35.7）
	不良	68（46.3）	119（64.3）
术前Mrs 0~2 [n（%）]		51（34.7）	55（29.7）	0.929	0.335
NIHSS [M（Q₁，Q₃）]		16（15，17）	15（14，17）	-0.713	0.476
ASPECTS [M（Q₁，Q₃）]		9（8，10）	9（8，9）	-2.227	0.026
溶栓史[n（%）]		33（22.4）	42（22.7）	0.003	0.956
核心梗死体积（n = 14）[M（Q₁，Q₃）]		34.5（17.25，44.75）	69（42.5，104）	-1.034	0.301
发病到穿刺时间[M（Q₁，Q₃）]		324（282，421）	328（255.5，447）	-0.434	0.664
穿刺到再通时间[M（Q₁，Q₃）]		125（100，170）	136（95，180）	-0.741	0.458
闭塞部位[n（%）]				5.249	0.154
	ICA	59（40.1）	88（47.6）
	MCA M1	69（47.0）	79（42.7）
	MCA M2	19（12.9）	18（9.7）
取栓方式[n（%）]				1.776	0.620
	血栓抽吸	33（22.4）	48（25.9）
	支架取栓	71（48.3）	86（46.5）
	中间导管辅助取栓	23（15.6）	33（17.8）
	支撑导管辅助支架取栓	20（13.6）	18（9.7）
取栓装置操作次数[M（Q₁，Q₃）]		1（1，2）	2（1，3）	-4.853	< 0.001
FPR [n（%）]		91（61.9）	65（35.1）	23.565	< 0.001
mTICI≥2B [n（%）]		132（89.8）	136（73.5）	13.956	< 0.001
sICH [n（%）]		6（4.1）	30（16.2）	12.476	0.001
90 d死亡[n（%）]		0（0）	16（8.6）	11.566^a	0.001
NLR1[M（Q₁，Q₃）]		3.90（3.09，4.87）	4.08（3.19，4.96）	-0.523	0.601
NLR2[M（Q₁，Q₃）]		6.51（5.35，7.99）	8.91（7.45，10.29）	-8.819	< 0.001
∆NLR[M（Q₁，Q₃）]		2.45（1.64，3.53）	4.61（3.67，5.68）	-10.794	< 0.001

	入院	术后3~7 d	检验值	P值
中性粒细胞	6.44 (5.47，7.45)	8.88 (7.34，9.84)	-14.618	< 0.001
淋巴细胞	1.67 (1.39，1.91)	1.13 (0.96，1.28)	-15.093	< 0.001
NLR	4.01 (3.16，4.93)	7.67 (6.24，9.44)	-15.792	< 0.001

	入院	术后3~7 d	检验值	P值
中性粒细胞	6.44 (5.47，7.45)	8.88 (7.34，9.84)	-14.618	< 0.001
淋巴细胞	1.67 (1.39，1.91)	1.13 (0.96，1.28)	-15.093	< 0.001
NLR	4.01 (3.16，4.93)	7.67 (6.24，9.44)	-15.792	< 0.001

	mTICI 2b~3	mTICI < 2b	Z值	P值
NLR1[M（Q₁，Q₃）]	4.08（3.17，4.94）	3.81（3.13，4.75）	-1.066	0.286
NLR2[M（Q₁，Q₃）]	7.54（6.02，9.22）	8.61（7.19，10.34）	-3.108	0.002
∆NLR[M（Q₁，Q₃）]	3.46（2.26，4.86）	4.70（3.66，6.08）	-4.908	< 0.001

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