Title:Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke
VOLUME: 17 ISSUE: 4
Author(s):Mei-Qi Wang, Ying-Ying Sun, Yan Wang, Xiu-Li Yan, Hang Jin, Xin Sun, Peng Zhang, Hong-Jing Zhu, Zhen-Ni Guo* and Yi Yang*
Affiliation:Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Clinical Trail and Research Center for Stroke, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Clinical Trail and Research Center for Stroke, The First Hospital of Jilin University, Chang Chun, Jilin, Department of Neurology, Stroke Center, Neuroscience Center, The First Hospital of Jilin University, Chang Chun, Jilin
Keywords:Acute ischemic stroke, intravenous thrombolysis, early neurological deterioration, hemorrhagic transformation,
delayed neurological deterioration.
Abstract:
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.
