Predictive Value Of Neutrophil-lymphocyte Ratio On Hemorrhagic Transformation In Patients With Atrial Fibrillation Complicated With Acute Ischemic Stroke

Objective: Increasing evidence suggests that neutrophil-lymphocyte ratio(NLR)is a risk factor for hemorrhagic transformation(HT)in patients with acute ischemic stroke(AIS)after reperfusion therapy.Patients with atrial fibrillation and AIS also have a higher incidence of hemorrhagic transformation,but the relationship between NLR and hemorrhagic transformation in atrial fibrillation complicated with AIS is not clear.This study aims to explore their relationship and timely identify patients at high risk for HT.Methods: Patients with atrial fibrillation complicated with AIS who were hospitalized in the Department of Neurology of the second Hospital of Hebei Medical University within 48 hours after stroke onset from January 2017 to December 2018 were retrospectively collected.Patients were divided into HT group and non-HT group according to whether the patients had HT.Basic patient information,laboratory data within 24 hours of admission and in-hospital imaging results were collected for statistical analysis.Results: We included 301 patients with atrial fibrillation complicated with AIS,48 in HT group and 253 in non-HT group.The level of NLR in HT group was significantly higher than that in non-HT group(6.98 vs.2.92,P<0.001).After adjusting for confounders,the level of NLR within 72 hours of onset was an independent risk factor for HT(odds ratio [OR] 1.232,95% confidence interval [CI] 1.091-1.392,P=0.001).The level of NLR within 72 hours of onset has a high ability to predict HT(area under curve [AUC] 0.800,95%CI 0.731-0.868,P<0.001).The optimal cutoff value of NLR that best distinguished the development of HT was 4.71.Its sensitivity was 72.9% and specificity was 75.5%.Patients with NLR≥4.71 had a 3.169-fold increased risk for HT compared to patients with NLR<4.71.Conclusions: In patients with atrial fibrillation complicated with AIS,the level of NLR within 72 hours of onset are independent risk factors for hemorrhage transformation.For patients with high NLR levels,the risk of HT should be noted and treatment that increases the risk of HT should be carefully administered.