Neutrophil-to-Lymphocyte Ratio after Intravenous Thrombolysis Is a Prognostic Marker in Acute Ischemic Stroke.

OBJECTIVES: The neutrophil-to-lymphocyte ratio (NLR) is an easily accessible biomarker that has been shown to predict the prognosis of acute ischemic stroke (AIS) patients. This study aimed to investigate the association between NLR on admission and within 24 hours after thrombolysis in A IS patients receiving intravenous thrombolysis (IVT) and the severity of stroke, infarction volume, hemorrhagic transformation (HT), and 90-day outcome. METHODS: Retrospective cohort study of 171 consecutive patients, the NLR value was calculated according to neutrophil and lymphocyte counts both on admission and after IVT. We defined the NLR value on admission as pre-IVT NLR and after IVT within 24 hours was defined as post-IVT NLR. We used the modified Rankin scale (mRS) to assess the 90-day outcome for AIS patients. Regression analyses were performed, adjusting for confounders. RESULTS: (1) Post-IVT NLR level was increased in the poor prognosis group, the moderate to severe group, large infarct volume group, and HT group. (2) In multivariate logistic regression analysis, the level of post-IVT NLR and post-IVT platelet-to-lymphocyte ratio (PLR) were correlated with the 90-day prognosis of AIS. Post-IVT NLR was an independent risk factor for predicting the prognosis of AIS patients with an adjusted OR of 1.212 (p = 0.001). Post-IVT NLR demonstrated superior prognostic accuracy compared to post-IVT PLR (AUC 0.738 vs. 0.601, p = 0.001), though remained inferior to NIHSS score (AUC 0.793) and infarction volume (AUC 0.808). CONCLUSION: Post-IVT NLR is related to the severity of stroke, infarction volume, HT, and 90-day outcome in AIS patients receiving IVT. Post-IVT NLR was an independent predictor (p = 0.001, OR 1.212) for predicting the prognosis of AIS.