Correlation Between PNR,PLR And Early Neurological Deterioration And Poor Prognosis After Intravenous Thrombolysis In Patients With AIS

Objective: To investigate the correlation of inflammatory markers ratio before Intravenous thrombolysis in patients with acute ischemic stroke（including platelet to eutrophic ratio,platelet to lymphocyte ratio,eutrophic to lymphocyte ratio,lymphocyte to monocyte,eosinophilic-to-monocyte ratio）and early neurological deterioration and poor prognosis at 3-month after Intravenous thrombolysis.Methods: A retrospective research method was adopted to screen and collect the clinical data of patients in the Department of Neurology,Yan’an University Affiliated Hospital from January 2019 to July 2021.All patients received recombination tissue-type plainsmen activator（rt-PA）Intravenous thrombolysis.Eutrophic counts（Ac）,lymphocytes counts（L）,platelets counts（P or PLT）,eosinophils counts（E）,and monocycle counts（M）were collected before Intravenous thrombolysis.Platelet to eutrophic ratio（PNR）,platelet to lymphocyte ratio（PLR）,eutrophic to lymphocyte ratio（NLR）,Lymphocyte to monocyte ratio（LMR）and eosinophil to monocyte ratio（EMR）.All patients with AIS who received Intravenous thrombolysis were divided into early neurological deterioration group and non-early neurological deterioration group according to whether the NIHSS score at 24 hours after Intravenous thrombolysis increased by ≥4 points compared with the NIHSS score at admission.According to the m RS score at 3 months,the patients were divided into a poor prognosis group（≥3 points）and a good prognosis group（≤2 points）.Through uni variate analysis,the risk factors affecting the early neurological function deterioration and poor prognosis of the patients were identified,and those risk factors were analyzed by binary logistic regression to find independent risk factors leading to early neurological deterioration and poor prognosis.Receiver operating characteristic（ROC）curves were obtained using the Medical 20.0.26 data package program to evaluate the predictive value of inflammatory markers ratio for early neurological deterioration and poor prognosis at 3-month in patients with AIS after Intravenous thrombolysis.Results:According to the inclusion and exclusion criteria,218 patients were finally included in this study,including 155 males（71.1%）and 63 females（28.9%）.A median age was 63（55,70）years.1.Risk factor analysis of early neurological deterioration: Through variate statistical analysis,age,cardiologist type,proximal vascular occlusion,time from onset to thrombolytic,systolic blood pressure,PNR,PLR,NLR and LMR before Intravenous thrombolysis in the early neurological deterioration group were significant differences than non-early neurological deterioration group（P<0.05）.The results of multivariate binary logistic regression analysis showed that after adjusting for confounding factors such as age,cardiologist type,proximal vascular occlusion,time from onset to thrombolytic,NLR and LMR before Intravenous thrombolysis.High levels of systolic blood pressure and PLR before Intravenous thrombolysis were an independent risk factor for early neurological deterioration in patients with AIS after Intravenous thrombolysis（OR=1.027,95%CI: 1.002-1.053,P<0.05;OR=1.006,95%CI: 1.000-1.012,P<0.05）;Low level of PNR before Intravenous thrombolysis was an independent protective factor for early neurological deterioration in patients with AIS after Intravenous thrombolysis（OR=0.939,95%CI: 0.905-0.974,P<0.05）.2.The predictive ability of PNR and PLR for early neurological deterioration in patients with AIS after Intravenous thrombolysis: ROC curve showed that the area under cure（AUC）of PNR before Intravenous thrombolysis was 0.759（CI: 0.697-0.814,P<0.05）.The best diagnostic cut-off value of PNR level before Intravenous thrombolysis for early neurological deterioration was 42.44,sensitivity = 95.7%,specificity = 52.3%.The AUC of PLR before Intravenous thrombolysis was 0.662（CI: 0.595-0.724,P <0.05）.The best diagnostic cutoff of PLR level before Intravenous thrombolysis for early neurological deterioration was 167.88,sensitivity=69.6%,specificity=69.7%.The AUC of PNR+PLR before Intravenous thrombolysis was 0.806（CI: 0.747-0.856,P<0.05）,sensitivity = 91.3%,specificity = 63.1%.with 0.7