Background and Purpose: Platelet-to-neutrophil ratio (PNR) was suggested to be an independent
protective predictor for 90-days outcomes in acute ischemic stroke (AIS) patients in previous
studies. This study aims to investigate the association between PNR and outcomes of AIS in
intravenous thrombolysis (IVT) group.
Methods: Data on acute ischemic stroke patients who received intravenous thrombolysis from April
2015 to March 2019 were collected. We defined the PNR value at admission as pre-IVT PNR and
after IVT within 24 h was defined as post-IVT PNR. Clinical outcome indicators included early neurological
deterioration (END), hemorrhagic transformation (HT), delayed neurological deterioration
(DND), and poor 3-month outcome (3m-mRS >2).
Results: A total of 581 patients were enrolled in the final analysis. The age was 61(53-69) years, and
423(72.8%) were males. Post-IVT PNR was independently associated with hemorrhagic transformation
(OR = 0.974; 95%CI = 0.956-0.992; P=0.006), early neurological deterioration (OR = 0.939;
95%CI = 0.913-0.966; P = 0.01), delayed neurological deterioration (OR = 0.949; 95%CI = 0.912-
0.988; P = 0.011), and poor outcome (OR = 0.962; 95%CI = 0.948-0.976; P<0.001). PNR level was
identified as high (at the cut-off value or above) or low (below the cut-off value) according to receiver
operating curve (ROC) analyses on each endpoint. Comparison of early neurological deterioration,
hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome
(3m-mRS >2) between patients at high and low levels for platelet-to-neutrophil ratio (PNR) showed
statistical differences (p<0.001).
Conclusion: Post-IVT PNR was independently associated with early neurological deterioration,
hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome. Lower
PNR can predict a worse outcome.