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- Title
Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19.
- Authors
Al-Mufti, Fawaz; Khandelwal, Priyank; Sursal, Tolga; Cooper, Jared B.; Feldstein, Eric; Amuluru, Krishna; Moré, Jayaji M.; Tiwari, Ambooj; Singla, Amit; Dmytriw, Adam A; Piano, Mariangela; Quilici, Luca; Pero, Guglielmo; Renieri, Leonardo; Limbucci, Nicola; Martínez-Galdámez, Mario; Schüller-Arteaga, Miguel; Galván, Jorge; Arenillas-Lara, Juan Francisco; Hashim, Zafar
- Abstract
Background: The neutrophil–lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19. Objective: We sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke. Methods: We analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated. Results: Incidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27–87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p =.003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2–38.6, p =.03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2–52.4, p =.03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p =.043, TICI p =.070). Conclusions: We show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy.
- Subjects
COVID-19; NEUTROPHIL lymphocyte ratio; ISCHEMIC stroke; COVID-19 pandemic; THROMBECTOMY
- Publication
Interventional Neuroradiology, 2023, Vol 29, Issue 4, p386
- ISSN
1591-0199
- Publication type
Article
- DOI
10.1177/15910199221093896