Role of Neutrophil-Lymphocyte Ratio in the Prognosis of Acute Ischaemic Stroke After Reperfusion Therapy: A Systematic Review and Meta-analysis

IF 2.6 Q2 CLINICAL NEUROLOGY

Journal of Central Nervous System Disease Pub Date : 2022-01-01 DOI:10.1177/11795735221092518

Divyansh Sharma, K. Spring, S. Bhaskar

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引用次数: 10

Abstract

Background Inflammation may mediate response to acute reperfusion therapy (RT) in acute cerebral ischaemia. Neutrophil-lymphocyte ratio (NLR), an inflammatory biomarker, may play an important role in acute ischaemic stroke (AIS) prognostication. Objective This meta-analysis sought to examine the effect of NLR on functional outcomes, mortality and adverse outcomes in AIS patients receiving RT. Methods Individual studies were retrieved from PubMed/Medline, EMBASE and Cochrane databases. Data were extracted using a standardised data sheet and meta-analysis on association of admission (pre-RT) or delayed (post-RT) NLR with clinical/safety outcomes after RT was conducted. Results Thirty-five studies (n = 10 308) were identified for the systematic review with 27 (n = 8537) included in the meta-analyses. Lower admission NLR was associated with good functional outcomes (GFOs), defined as 3-month modified Rankin scale (mRS) 0–2 (SMD = −.46; 95% CI = −.62 to −.29; P < .0001), mRS 0–1 (SMD = −.44; 95% CI = −.66 to −.22; P < .0001) and early neurological improvement (ENI) (SMD = −.55; 95 %CI = −.84 to −.25; P < .0001). Lower delayed admission NLR was also associated with GFOs (SMD = −.80; 95%CI = −.91 to −.68; P < .0001). Higher admission NLR was significantly associated with mortality (SMD = .49; 95%CI = .12 to .85; P = .009), intracerebral haemorrhage (ICH) (SMD = .34; 95% CI = .09 to .59; P = .007), symptomatic ICH (sICH) (SMD = .48; 95% CI = .07 to .90; P = .022) and stroke-associated infection or pneumonia (SMD = .85; 95% CI = .50, 1.19; P < .0001). Higher delayed NLR was significantly associated with sICH (SMD = 1.40; 95% CI = .60 to 2.19; P = .001), ICH (SMD = .94; 95% CI = .41 to 1.46; P < .0001) and mortality (SMD = 1.12; 95% CI = .57 to 1.67; P < .0001). There were variations in outcomes across RT groups. Conclusion Higher admission or delayed NLR is significantly associated with worse morbidity, mortality and safety outcomes in AIS patients receiving RT.

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中性粒细胞-淋巴细胞比率在急性缺血性脑卒中再灌注治疗后预后中的作用：系统评价和荟萃分析

背景炎症可能介导急性脑缺血对急性再灌注治疗（RT）的反应。中性粒细胞-淋巴细胞比率（NLR）是一种炎症生物标志物，可能在急性缺血性脑卒中（AIS）的预后中发挥重要作用。目的本荟萃分析旨在检验NLR对接受RT的AIS患者的功能结果、死亡率和不良结果的影响。方法从PubMed/Medline、EMBASE和Cochrane数据库中检索个体研究。使用标准化数据表和荟萃分析提取数据，研究入院（放疗前）或延迟（放疗后）NLR与放疗后临床/安全性结果的关系。结果35项研究（n=10 308）被确定为系统综述，其中27项（n=8537）被纳入荟萃分析。较低的入院NLR与良好的功能结果（GFO）相关，定义为3个月的改良兰金量表（mRS）0-2（SMD=−.46；95%CI=−.62至−.29；P<.0001），mRS 0–1（SMD=−.44；95%CI=−.66至−.22；P<.0001）和早期神经系统改善（ENI）（SMD=−.55；95%CI=−.84至−.25；P<0.0001）。较低的延迟入院NLR也与GFO相关（SMD=−.80；95%CI=−.91至−.68；P<.001）。较高的入院NLR与死亡率显著相关（SMD=.49；95%CI=0.12至.85；P=.009），脑出血（ICH）（SMD=.34；95%CI=0.09至.59；P=0.007）、症状性ICH（sICH）（SMD=.48；95%CI=0.07至.90；P=0.022）和中风相关感染或肺炎（SMD=.85；95%CI=0.501.19；P<.0001）。较高的延迟NLR与sICH显著相关（SMD=1.40；95%CI=0.60至2.19；P=0.001），ICH（SMD=.94；95%CI=.41至1.46；P<.0001）和死亡率（SMD=1.12；95%CI=.57至1.67；P<0.0001）。RT组的结果存在差异。结论在接受RT的AIS患者中，较高的入院率或延迟的NLR与较差的发病率、死亡率和安全性结果显著相关。

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来源期刊

Journal of Central Nervous System Disease CLINICAL NEUROLOGY-

CiteScore

6.90

自引率

0.00%

发文量

审稿时长

8 weeks