Effects of hematological parameters on long term mortality in acute ischemic stroke patients

Year 2024, Volume: 5 Issue: 5, 277 - 283, 26.10.2024

Nazmi Yaman , Kamil Doğan , Özlem Güler , Buket Tuğan Yıldız

Abstract

Aims: Mortality can be seen in acute ischemic stroke (AIS) in the early or late period. We investigated the role of mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and stroke volume in late-term mortality.
Methods: This retrospective cross-sectional study included 132 AIS patients who applied to the emergency department of a university hospital over a consecutive 12-month period. Some patients were excluded from the study according to the exclusion criteria. Patients were divided into groups as survivors and deceased. MPV, NLR, PLR levels in each group were evaluated according to the National Institutes of Health Stroke Scale (NIHSS) scores. Diffusion-weighted MR images (DWI MRs) were evaluated and the infarct volumes of the patients were calculated.
Results: The data of a total of 83 AIS patients who remained after exclusion were analyzed. The mean age, NIHSS score and infarct volume of the deceased were statistically significantly higher than the survivors (p<0.01, p=0.026, p=0.021, respectively). According to Spearman’s analysis, NLR, MPV and PLR were negatively correlated with Glasgow Coma Scale (GCS) at presentation, while they were positively correlated with NIHSS and infarct volume. In ROC curve analysis, the optimal cut-off values of NLR, MPV and PLR as predictors of long-term mortality were determined as 4.68, 7.20 and 167.66, respectively. At this level, their sensitivities were 54.84, 48.39, 61.29, respectively, their specificities were 75, 73.08, 73.8, respectively, their positive predictive values were 56.7, 51.7, 57.6, respectively, and their negative predictive values were 73.6, 70.4, 76, respectively, (AUC: 0.64[0.52-0.74 95% CI], 0.64[0.52-0.74 95% CI], 0.66[0.55-0.76 95% CI]).
Conclusion: The results showed that MPV, PLR, infarct volume and mean age were independentpredictors of 3-year all-cause mortality in AIS patients.

Keywords

Ischemic stroke, mean platelet volume, neutrophil/ lymphocyte ratio, platelet lymphocyte ratio, mortality

Ethical Statement

The study followed the tenets of the Declaration of Helsinki and was approved by the institutional ethics committee (approval number: 2018/15/30).

Supporting Institution

YOK.

Akut iskemik inme hastalarında hematolojik parametrelerin uzun dönem mortalite üzerine etkisi

Abstract

ÖZET
Amaç: Akut iskemik inmede (Aİİ) erken ya da geç dönemde mortalite görülebilmektedir. Geç dönem mortalitesinde mean platelet volüm (MPV), nötrofil lenfosit oranı (NLR), platelet lenfosit oranı (PLR) ve enfarkt hacminin rolünü araştırdık.
Yöntem: Bu retrospektif kesitsel çalışmaya ardışık 12 aylık bir sürede bir üniversite hastanesinin acil servisine başvuran 132 Aİİ hasta alındı. Dışlama kriterlerine göre bazı hastalar çalışmadan çıkarıldı. Hastalar hayatta kalan ve ölen olarak gruplara ayrıldı. Her grupta MPV, NLR, PLR seviyeleri, National Institutes of Health Stroke Scale (NIHSS) skorlarına göre değerlendirildi. Difüzyon ağırlıklı MR görüntüleri (DWI MRs) değerlendirilerek hastaların enfarkt hacimleri hesaplandı.
Bulgular: Dışlama sonucu geride kalan toplam 83 Aİİ’li hastanın verileri analiz edildi. Ölenlerin ortalama yaşı, NIHSS skoru ve enfarkt hacmi hayatta kalanlardan istatistiksel olarak anlamlı derecede daha yüksekti (sırası ile p˂0,01, p=0,026, p=0,021). Sperman’s analizine göre, NLR, MPV ve PLR başvuru anındaki GCS ile negatif olarak korelasyon gösterir iken NIHSS ve enfarkt hacmi ile pozitif olarak korelasyon gösterdiği saptandı. ROC eğrisi analizinde uzun dönem mortalite belirleyicisi olarak, NLR, MPV ve PLR’nin optimal cut-off değerleri sırasıyla 4,68, 7,20 ve 167,66 olarak belirlendi. Bu seviyede sensitiviteleri sırasıyla 54,84, 48,39, 61,29, spesifiteleri sırasıyla 75, 73,08, 73,8, pozitif prediktivite değerleri sırasıyla 56,7, 51,7, 57,6 ve negatif prediktivite değerleri sırasıyla 73,6, 70,4, 76 idi. (AUC: 0,64[0,52-0,74 %95 CI], 0,64[0,52-0,74 %95 CI], 0,66[0,55-0,76 %95 CI]).
Sonuç: Sonuçlar MPV, PLR, enfarkt hacmi ve ortalama yaşın, Aİİ hastalarında 3 yıllık tüm nedenlere bağlı mortalitede bağımsız prediktör olduğunu gösterdi.

Keywords

İskemik inme, platelet lenfosit oranı, mortalite., mean platelet volüm, nötrofil lenfosit oranı

References

• Altintas O, Altintas MO, Tasal A, Kucukdaglı OT, Asil T. The relationship of platelet-to- lymphocyte ratio with clinical outcome and final infarct core in acute ischemic stroke patients who have undergone endovascular therapy. Neurol Res. 2016;38(9):759-765. doi:10.1080/01616412.2016.1215030
• Nandakumar N. Diffusion weighted imaging in acute ischemic stroke: a review of its interpretation pitfalls and advanced diffusion imaging application. J Neurol Sci. 2021;425: 117435. doi:10.1016/j.jns.2021.117435
• Tuttolomondo A, Puleo MG, Velardo MC, Corpora F, Daidone M. Molecular biology of atherosclerotic ischemic strokes. Int J Mol Sci. 2020;21(24): 9372. doi:10.3390/ijms21249372
• Staszewski J, Pogoda A, Data K, et al. The mean platelet volume on admission predicts unfavorable stroke outcomes in patients treated with IV thrombolysis. Clin inter aging. 2019;493-503. doi:10.2147/CIA.S195451
• Przykaza Ł. Understanding the connection between common stroke comorbidities, their associated inflammation, and the course of the cerebral ischemia/reperfusion cascade. Front Immunol. 2021;12:782569. doi:10.3389/fimmu.2021.782569
• Stanzione R, Forte M, Cotugna M, Bianchi F, Marchitti S, Rubattu S. Role of DAMPs and of leukocytes infiltration in ischemic stroke: insights from animal models and translation to the human disease. Cell Mol Neurobiol. 2022;42(3):545-556 doi:10.1007/s10571-020- 00966-4
• Muela H, Sandala FM, Tito JAJ, et al. Neutrophil-lymphocyte ratio and coronary artery disease risk in patients undergoing coronary angiography. EC Cardiology. 2023;10:19-27.
• Velioglu Y, Yuksel A. Complete blood count parameters in peripheral arterial disease. The Aging Male. 2019;22(3):187-191. doi:10.1080/13685538.2019.1588873
• Tudurachi BS, Anghel L, Tudurachi A, Sascau RA, Statescu C. Assessment of inflammatory hematological ratios (NLR, PLR, MLR, LMR and monocyte/HDL–cholesterol ratio) in acute myocardial infarction and particularities in young patients. Int J Mol Sci. 2023;24(18):14378. doi:10.3390/ijms241814378
• Cho KI, Ann SH, Singh GB, Her AY, Shin ES. Combined usefulness of the platelet-to- lymphocyte ratio and the neutrophil-to-lymphocyte ratio in predicting the long-term adverse events in patients who have undergone percutaneous coronary intervention with a drug-eluting stent. PLoS One. 2015;10(7): e0133934. doi:10.1371/journal.pone.0133934
• Kotfis K, Bott-Olejnik M, Szylinska A, Rotter I. Could neutrophil-to-lymphocyte ratio (NLR) serve as a potential marker for delirium prediction in patients with acute ischemic stroke? A prospective observational study. JCM. 2019;8(7):1075. doi:10. 3390/jcm8071075
• Farah R, Nava S. Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke. J Clin Lab Anal. 2018; 32(1):e22189. doi:10.1002/jcla.22189
• Faber J, Hvas AM, Kristensen SD, Grove EL, Adelborg K. Immature platelets and risk of cardiovascular events among patients with ischemic heart disease: a systematic review. Thromb Haemost. 2021;121(5):659-675. doi:10.1055/ s-0040-1721386
• Mayda-Domaç F, Mısırlı H, Yılmaz M. Prognostic role of mean platelet volume and platelet count in ischemic and hemorrhagic stroke. J Stroke Cerebrovasc. 2010;19(1):66-72. doi:10.1016/j.jstrokecerebrovasdis.2009.03.003
• Lok U, Gulacti U, Ekmekci B, Bulut T, Celik M. Predictive and prognostic role of mean platelet volume in patients with first-ever acute ischemic stroke. Neurosciences J. 2017;22(2):119-126. doi:10.17712/nsj.2017.2.20160330
• Mohamed AAB, Elnady HM, Alhewaig HK, Hefny HM, Khodery A. The mean platelet volume and plateletcrit as predictors of short-term outcome of acute ischemic stroke. Egypt J Neurol Psychiatry Neurosurg. 2019;55:1-6. doi:10.1186/s41983-018-0035-x
• Ray B, Tinsley L, Ford L, Thompson DM, Sidorov EV, Bohnstedt BN. Trends of platelet volume index predicts delayed cerebral ischemia after subarachnoid hemorrhage. World Neurosurg. 2018;111:e624-e631. doi:10.1016/j.wneu.2017.12.131
• Osadnik T, Wasilewski J, Lekston A, et al. The platelet-to-lymphocyte ratio as a predictor of all-cause mortality in patients with coronary artery disease undergoing elective percutaneous coronary intervention and stent implantation. JSHA. 2015;27 (3):144-151. doi:10.1016/j.jsha.2015.02.004
• Temiz A, Gazi E, Gungor O, et al. Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction. Med sci monit: İnt Med J Exp Clin Res. 2014;20:660. doi:10.12659/MSM.890152
• Kurtul A, and Ornek E. Platelet to lymphocyte ratio in cardiovascular diseases: a systematic review. Angiology. 2019;70 (9):802-818. doi:10.1177/0003319719845186
• Liu Y, Sun W, Guo Y, et al. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelets. 2020;31(4):490-496. doi:10.1080/09537104.2020.1754383
• Yang X, Yang Q, Wang Y, et al. Thrombocytopenia and its association with mortality in patients with COVID‐19. J Thromb Haemost. 2022;18(6):1469-1472. doi:10.1111/jth.14848
• Lee SH, Jang MU, Kim Y, et al. The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict reperfusion and prognosis after endovascular treatment of acute ischemic stroke. J. Pers. Med. 2021;11(8):696. doi:10.3390/jpm11080696