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Current Neurovascular Research

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ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

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Research Article

Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke

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*

Volume 17, Issue 4, 2020

Page: [411 - 419] Pages: 9

DOI: 10.2174/1567202617666200517111802

open access plus

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.

Keywords: Acute ischemic stroke, intravenous thrombolysis, early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration.

« Previous Next »
[1]
Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet 2008; 371(9624): 1612-23.
[2]
Meschia JF, Brott T. Ischaemic stroke. Eur J Neurol 2018; 25(1): 35-40.
[http://dx.doi.org/10.1111/ene.13409] [PMID: 28800170]
[3]
Ho WM, Reis C, Akyol O, et al. Pharmacological management options to prevent and reduce ischemic hemorrhagic transformation. Curr Drug Targets 2017; 18(12): 1441-59.
[http://dx.doi.org/10.2174/1389450117666160818115850] [PMID: 27538508]
[4]
Andrews RK, López JA, Berndt MC. Molecular mechanisms of platelet adhesion and activation. Int J Biochem Cell Biol 1997; 29(1): 91-105.
[http://dx.doi.org/10.1016/S1357-2725(96)00122-7] [PMID: 9076944]
[5]
Gremmel T, Frelinger AL III, Michelson AD. Platelet physiology. Semin Thromb Hemost 2016; 42(3): 191-204.
[http://dx.doi.org/10.1055/s-0035-1564835] [PMID: 26926581]
[6]
Holinstat M. Normal platelet function. Cancer Metastasis Rev 2017; 36(2): 195-8.
[http://dx.doi.org/10.1007/s10555-017-9677-x] [PMID: 28667366]
[7]
Diacovo TG, Roth SJ, Buccola JM, Bainton DF, Springer TA. Neutrophil rolling, arrest, and transmigration across activated, surface-adherent platelets via sequential action of P-selectin and the beta 2-integrin CD11b/CD18. Blood 1996; 88(1): 146-57.
[http://dx.doi.org/10.1182/blood.V88.1.146.146] [PMID: 8704169]
[8]
Hagberg IA, Roald HE, Lyberg T. Adhesion of leukocytes to growing arterial thrombi. Thromb Haemost 1998; 80(5): 852-8.
[PMID: 9843183]
[9]
Segel GB, Halterman MW, Lichtman MA. The paradox of the neutrophil’s role in tissue injury. J Leukoc Biol 2011; 89(3): 359-72.
[http://dx.doi.org/10.1189/jlb.0910538] [PMID: 21097697]
[10]
Kolaczkowska E, Kubes P. Neutrophil recruitment and function in health and inflammation. Nat Rev Immunol 2013; 13(3): 159-75.
[http://dx.doi.org/10.1038/nri3399] [PMID: 23435331]
[11]
Jickling GC, Liu D, Ander BP, Stamova B, Zhan X, Sharp FR. Targeting neutrophils in ischemic stroke: Translational insights from experimental studies. J Cereb Blood Flow Metab 2015; 35(6): 888-901.
[http://dx.doi.org/10.1038/jcbfm.2015.45] [PMID: 25806703]
[12]
Bednarska K, Król E, Głowacka E, et al. Analysis of preoperative blood platelet parameters in terms of diversity of epithelial ovarian cancer. Medicine (Baltimore) 2018; 97(12): e0180-80.
[http://dx.doi.org/10.1097/MD.0000000000010180] [PMID: 29561432]
[13]
Jin P, Li X, Chen J, et al. Platelet-to-neutrophil ratio is a prognostic marker for 90-days outcome in acute ischemic stroke. J Clin Neurosci 2019; 63: 110-5.
[http://dx.doi.org/10.1016/j.jocn.2019.01.028] [PMID: 30737090]
[14]
Ren B, Duan M, Liu Z, et al. fibrinogen, neutrophil-to-lymphocyte rate and platelet-to-neutrophil rate as novel acute phase indicators in patients with thromboangiitis obliterans. Ann Vasc Surg 2019; 65: 137-44.
[15]
Long H, Qin K, Chen J, et al. Biomarkers of gastric cancer-related ischemic stroke and its underlying pathogenesis. Medicine (Baltimore) 2018; 97(17): e0493-93.
[http://dx.doi.org/10.1097/MD.0000000000010493] [PMID: 29703010]
[16]
Perez-de-Puig I, Miró-Mur F, Ferrer-Ferrer M, et al. Neutrophil recruitment to the brain in mouse and human ischemic stroke. Acta Neuropathol 2015; 129(2): 239-57.
[http://dx.doi.org/10.1007/s00401-014-1381-0] [PMID: 25548073]
[17]
Chen Y, Xiao Y, Lin Z, et al. the role of circulating platelets microparticles and platelet parameters in acute ischemic stroke patients. J Stroke Cerebrovasc Dis 2015; 24(10): 2313-20.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.018] [PMID: 26169549]
[18]
Rubenstein MH, Finn AV, Leinbach RC, et al. Short-term intravenous eptifibatide infusion combined with reduced dose recombinant tissue plasminogen activator inhibits platelet recruitment at sites of coronary artery injury. J Am Coll Cardiol 2004; 43(2): 287-94.
[http://dx.doi.org/10.1016/j.jacc.2003.08.039] [PMID: 14736451]
[19]
Matosevic B, Knoflach M, Werner P, et al. Fibrinogen degradation coagulopathy and bleeding complications after stroke thrombolysis. Neurology 2013; 80(13): 1216-24.
[http://dx.doi.org/10.1212/WNL.0b013e3182897015] [PMID: 23486872]
[20]
Gensicke H, Al Sultan AS, Strbian D, et al. Thrombolysis in Stroke Patients (TRISP) Collaborators Intravenous thrombolysis and platelet count. Neurology 2018; 90(8): e690-7.
[http://dx.doi.org/10.1212/WNL.0000000000004982] [PMID: 29367438]
[21]
Maestrini I, Strbian D, Gautier S, et al. Higher neutrophil counts before thrombolysis for cerebral ischemia predict worse outcomes. Neurology 2015; 85(16): 1408-16.
[http://dx.doi.org/10.1212/WNL.0000000000002029] [PMID: 26362283]

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