Study On The Relationship Between The Neutrophil To Lymphocyte Ratio And The Prognosis Of Endovascular Interventional Therapy

ObjectiveThe relationship between the neutrophil to lymphocyte ratio(NLR)and the outcome of patients with anterior circulation large vessel occlusion(LVO)who acess to successful reperfusion after endovascular interventional therapy(EVT)was observed dynamically.MethodsIn this study,117 patients with anterior circulation LVO who underwent EVT in the Department of Neuro-intervention,Hebei General Hospital from January 2020 to February 2022 were collected consecutively.All patients collected neutrophil counts,lymphocyte counts,NLR and other baseline data collected on the day of admission,1 day after sur gery and 5-7 days after surgery.The patients were divided into massive cerebral infarction group(N =30)and no massive cerebral infarction group(N= 87)according to whether CT infarct size was > 1/3 of MCA blood supply area on 3-7 days after EVT.According to the European collaborative study on acute stroke II(ECASS II)classification,We divided the patients into symptomatic intracerebral hemorrhage group(SICH,N =16)and asymptomatic intracerebral hemorrhage group(aSICH,N =23).The patients were divided into good prognosis group(N= 68)and ba d prognosis group(N= 49)according to mRS at 90 days after operation.The levels of neutrophil counts,lymphocyte counts and NLR were compared between groups at different time points.Logistic regression analys is was performed to determine the independent predictors of poor funct ional outcome after EVT,receiver operating characteristic curve(ROC)and area under curve(AUC)were used to determine the diagnostic value of NLR and other related factors.Results1.Compared with the nonmassive cerebral infarction group,the neutrophil counts and NLR of the massive cerebral infarction group were significantly higher on the first day after EVT and 5-7 days after EVT(P< 0.05).On the contrary,the number of lymphocyte decreased significantly on the first day after operation(P< 0.05).Compared with a SICH group,the neutrophil counts and NLR in the SICH group increased significantly on the first day and 5-7 days after EVT(P<0.05).Compared with good prognosis group,the neutrophil counts and NLR in the group with poor prognosis were significantly higher on the first day and 5-7days after EVT(P<0.001),but the lymphocyte counts was signific antly lower on the first day and 5-7 days after EVT(P<0.05).2.Independent risk factors for poor functional outcome after EVT included age(OR = 1.068,95% CI 1.020-1.117,P = 0.005),hemorrhagic transformation(OR = 3.924,95% CI 1.387-11.098,P = 0.01),tandem lesion(OR= 2.886,95% CI 1.119-7.441,P = 0.028),higher NLR on the first postoperative day(OR= 1.108,95% CI 1.030-1.191,P= 0.006),and higher NLR on the 5-7 days after operation(OR = 1.241,95% CI 1.105-1.394,P< 0.001).3.The AUC was 0.823 in the conventional model(age,hemorrhage transformation,and tandem lesion).While we added NLR on Day 1 after EVT or NLR on Day 5-7 after EVT to the conventional model,the AUC of the optimized model was 0.852 and 0.879 respectively.Conclusion1.Patients in the massive cerebral infarction group had higher neutrophil counts,NLR levels and lower lymphocyte counts on postoperative day 1 and 5-7,compared with patients in the nonmassive cerebral infarction group.2.Compared with aSICH group,patients in SICH group had higher neutrophil counts and NLR level on the first day and 5-7day after oper ation.3.Patients with poor prognosis had higher neutrophil counts and NLR level on postoperative day 1 and 5-7,and lower lymphocyte counts on postoperative day 1 and 5-7,comparing with poor prognosis patients.4.The independents of poor prognosis in anterior circulation LVO patients after EVT include age,hemorrhagic transformation,tandem lesion,and elevated NLR on postoperative day 1 and days 5-7 as independent risk factors.5.NLR after suigery,in particular the NLR on day 5-7 after EVT improved the prognostic assessment of the conventional models.