THE OUTCOME EVALUATION OF AN ACUTE ISCHAEMIC STROKE IN THE POSTERIOR REGION IN RELATION TO ROUTINE BLOOD COUNT PARAMETERS – NEUTROPHIL/LYMPHOCYTE RATIO, PLATELETCRIT AND MEAN PLATELET VOLUME
Abstract
Introduction: Acute stroke is defined as a focal or global disorder of brain function that occurs suddenly and is the third leading cause of death in the world. Depending on the mechanism of occurrence, it can be classified as acute ischemic stroke and acute hemorrhagic stroke.
The work aims to examine the hypothesis that the ratio of neurtophils to lymphocytes (NLR), thrombocrit (Pct) and mean platelet volume (MVP) are significantly increased in patients with a worse outcome of a stroke in the posterior basin.
Material and methods: The basis of the methodology is the analysis of laboratory data of 205 patients with ischemic stroke of the posterior basin with data on the modified Rankin score at discharge, which were adjusted into ranks for three possible treatment outcomes: good, moderately bad, and bad disease outcomes.
Results: The strongest predictor of the outcome was the increase in the ratio of neutrophils and lymphocytes (NLR), which correlates with a poor outcome of the disease (p < 0,001). Thrombocrit also shows a moderate degree of association with the outcome of posterior basin ischemic stroke graded by ranks of the modified Rankin score (p = 0,002). The mean volume of platelets, in this sample of subjects, did not show either a statistical significance of the difference between the groups of patients according to the outcome of the disease graded by the ranks of the modified Rankin score, or a correlation with the outcome of the disease according to the same criterion.
Conclusion: Neutrophil to lymphocyte ratio (NLR), as well as thrombocrit (Pct), are variables that, based on this study and the results from the available literature, are significantly more often elevated in patients with a worse outcome of a stroke in the posterior basin where they represent a predictor of a worse outcome of the disease.
References
Nikolić G, Čukić M, Eraković J, Nikolić G. Akutni ishemijski moždani udar – nacionalne smjernice dobre kliničke prakse. Ministarstvo zdravlja Crne Gore. 2012; 1-44.
Republička stručna komisija za izradu i implementaciju vodiča dobre kliničke prakse. Nacionalni vodič dobre kliničke prakse za dijagnostikovanje i lečenje ishemijskog moždanog udara. Ministarstvo zdravlja Republike Srbije. 2011, oktobar; 4/11: 1-82.
Al-Amir Bassiouny M, Hassan ME, Hazem KA, Hesham MH and Ashraf K. The mean platelet volume and plateletcrit as predictors of short-term outcome of acute ischemic stroke. Egypt J Neurol Psychiatr Neurosurg. 2019 Jan; 55(1): 4. doi: 10.1186/s41983-018-0035-x.
Xue J, Huang W, Chen X, Li Q, Zhengyi Cai Z, Tieer Yu T et al. Neutrophil-to-lymphocyte ratio is a prognostic marker in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2017 Dec; 26:650-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.010.
Herz J, Sabellek P, Lane TE, Gunzer M, Hermann DM, Doeppner TR. Role of neutrophils in exacerbation of brain injury after focal cerebral ischemia in hyperlipidemic mice. Stroke. 2015 Oct;46:2916-25. doi: 10.1161/STROKEAHA.115.010620.
Buck BH, Liebeskind DS, Saver JL, Bang OY, Yun SW, Starkman S, et al. Early neutrophilia is associated with volume of ischemic tissue in acute stroke. Stroke. 2008 Feb;39:355-60. doi: 10.1161/STROKEAHA.107.490128.
Kim J, Song TJ, Park JH, Lee HS, Nam CM, Nam HS et al. Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis. 2012 Jun;222:464-7. doi: 10.1016/j.atherosclerosis.2012.02.042.
Maestrini I, Strbian D, Gautier S, Haapaniemi E, Moulin S, Sairanen T, et al. Higher neutrophil counts before thrombolysis for cerebral ischemia predict worse outcomes. Neurology. 2015 Oct;85:1408-16. doi: 10.1212/WNL.0000000000002029.
Brooks SD, Spears C, Cummings C, VanGilder RL, Stinehart KR, Laurie Gutmann L, et al. Admission neutrophil lymphocyte ratio predicts 90 day outcome after endovascular stroke therapy. J Neurointerv Surg 2014 Oct;6:578–83. doi: 10.1136/neurintsurg-2013-010780.
Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP. Platelets as predictors of vascular risk: is there a practical index of platelet activity? Clin Appl Thromb Hemost. 2003 Jul;9(3):177-90. doi: 10.1177/107602960300900301.
Jesty J, Yin W, Perrotta P, Bluestein D. Platelet activation in a circulating flow loop: combined effects of shear stress and exposure time. Platelets. 2003 May; 14(3):143-9. doi: 10.1080/0953710031000092839.
del Zoppo GJ. The role of platelets in ischemic stroke. Neurology. 1998 Sep;51(3 Suppl 3): 9-14. doi: 10.1212/wnl.51.3_suppl_3.s9.
O'Malley T, Langhorne P, Elton RA, Stewart C. Platelet size in stroke patients. Stroke. 1995 Jun;26(6):995-9. doi: 10.1161/01.str.26.6.995.
Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract. 2009 Oct; 63(10):1509-15. doi: 10.1111/j.1742-1241.2009.02070.x.
D’Erasmo E, Aliberti G, Celi FS, Romagnoli E, Vecci E, Mazzuoli GF. Platelet count, mean platelet volume and their relation to prognosis in cerebral infarction. J Intern Med. 1990 Jan; 227:11-14. doi: 10.1111/j.1365-2796.1990.tb00111.x.
Greisenegger S, Endler G, Hsieh K, Tentschert S, Mannhalter C, Lalouschek W. Is elevated mean platelet volume associated with a worse outcome in patients with acute ischemic cerebrovascular events? Stroke. 2004 Jul; 34: 1688-91. doi: 10.1161/01.STR.0000130512.81212.a2.
